E for Ecstasy 0950162884, 9780950162881

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EP tor Ecstasy by Nicholas Saunders

bibliography by Alexander Shulgin edited by Liz Heron

Thanks to all the people who gave me their time assistance in providing information; to the people who wrote stories of their personal experiences and those who answered questionnaire. In particular, Rick Doblin who checked manuscript and Alexander Shulgin who freely provided bibliography.

and the the my the

©Nicholas Saunders 1993

First published 1993 by Nicholas Saunders 14 Neal’s Yard London WC2H 9DP

"

Typeset by the author at Neal’s Yard Desktop Publishing Studio Printed in England by Biddles of Guildford

ISBN: 0950162884

— E for Ecstasy

The quotations included in this book are intended to demonstrate various effects of MDMA. Some characters and situations are combinations

of several

in real life, while details have been changed in order to maintain anonymity.

However, I have been careful to portray situations which reflect the essence of those they are based on.

This book is not an encouragement to break the law. The purpose of this book is to provide the public with information to enable them to make their own decisions. For regular users of MDMA, and those who have already decided to try the drug, this book provides the knowledge to minimise the risks involved and maximise the benefits.

I strongly believe that individual freedom depends on the individual’s access to information. This contains all the information that I have been able to gather on MDMA, and is intended to fill the gap left by the media. Nicholas Saunders, April 1993

Contents

1: Introduction

Ti

2: My own experience

with E 8 Problem solving ------------ 11 3: History of Ecstasy

13

4: What E does and how it

works 19 Psychiatric effects ---------- 19 Spiritual effects ------------- 20 Effects at raves -------------- 20 Side-effects +----------------- 21 After-effects ------------------ Z2 Medical effects -------------- Ze How MDMA effects mood23 Combining Ecstasy with other drugs -------------- 24 Drugs with similar effects 24 S€X ----------------------------- 2

5: Who takes Ecstasy? How many people take

28

6: The dangers of Ecstasy 39 Immediate medical dangers 59 Overheating ----------------- 40 Medium term medical dangers ------------------- 41 Long term effects ----------- 42 Contaminants --------------- 44 Psychological dangers ----44 Addiction --------------------- 45 Overdosing ------------------ 46 Can Ecstasy use lead on to other drugs? ------------- 46 Risk of death ---------------- 46 How many deaths are due to Ecstasy? ---------------- 46 Permanent damage to

health --------------------Temporary damage to health --------------------Catching colds and other infections ----------------Social dangers-—-------—-—

48

49 49

49

Ecstasy? ------------------- 28

What kind of people take Ecstasy? ------------------- 29 Own survey ----------------- 30

E hits a rural community -32

Football supporters -------- 35

7: The Law Penalties ===

51 ——--———- 51

How the law is applied ---53

POSSESSION === =— 53 Supply

54 -----~--- ~~~

------------

What to do if arrested ----- 54 Searches and warrants ----54 Blood and urine tests ----- i, Police policy trends -------55

Relieving pain --------------- 94 Psychological research ---94

11: Suggestions for first

time users 8: Ecstasy and the media 56 Press scare stories -—-——- Sw

95

Health ------------------------- 95 Situation ---------------------- 95 Looking after yourself ----95

Mn eaines 2 Sete A 57

Guide ------------------------- 96 Preparations ----------------- 96

9: Psychotherapeutic use

Timing ------------------------ o7

in Switzerland

59

Comparative study ---------60

Rules -------------------------- 97 Notes for guides ------------ OF

Interview with Dr. Bloch-61 Dr: Styk =—-—=---—--—-_-—-- ve

a Dewidmer——-— es Dro ROU

78 80

In primates”, the closest animals to man, there is no evidence that

43

44

the dangers of Ecstasy — psychological

normal doses of MDMA have negative long-term effects. With high doses, Ricuarte has found that serotonin levels in primates do not recover even after 18 months, although there have been signs that cell damage may regenerate”? The likelihood of MDMA causing long-term brain damage must be less than for many new drugs prescribed by doctors because of its use on an enormous scale over the last few years without any reports of

actual brain damage.” Contaminants Another danger is that what you bought as E is mixed with a poison of some kind, or an addictive drug like heroin. Although this is a possibility, it doesn’t appear to happen. Dr. John Henry of the National Poisons Unit looks for poisons in the blood and urine of people who have died or are seriously ill after taking drugs, and says he has not come across any such cases.” And Dr. Les King, who analyses suspected drugs seized by the police at the Aldermaston forensic laboratory has never come across (or even heard of) poisonous additives to Ecstasy, although he does not specifically test for them.™ In Holland, where the government has a far more liberal attitude, people are employed to buy drugs sold on the street in Amsterdam. They are analysed and the results are then made public. Once again, poisons and addictive drugs have not been found mixed with drugs

sold as Ecstasy.”!

Psychological dangers In my opinion, there is a far greater risk of damaging the mind than of damaging the body through taking MDMA. While scientists argue about whether there is any evidence of physical damage, instances of mental damage are easy to find. Just as I have witnessed people whose lives appear to have been enriched by MDMA, there are others whose lives have got worse, if not actually been ruined as the tabloid papers would have it. Ecstasy has a profound effect on many people, and this is not always for the better. People may be pushed into taking Ecstasy by peer group pressure, and be made to feel inferior if they do not enjoy it. For instance, some people will claim that Ecstasy can do nothing but to bring out your true personality by removing ‘blocks’ or defences. While this may be true in a sense, there are many perfectly sane people who do not feel liberated by taking MDMA, and, for whatever reason, they do not enjoy it.

the dangers of Ecstasy — addiction

There are also those who do enjoy the drug but suffer from the psychological effects. Very often this is from taking too much too often, resulting in paranoia and depression. Others simply find that everyday life is boring by comparison, and lose motivation. It is difficult to identify these dangers without further research, as there are always other factors involved with psychological problems, for instance other drugs. The stories I have heard about people whose lives have been ‘screwed up’ by Ecstasy have always involved taking large amounts or taking other drugs as well. In addition, there are the stories of first time users who have ‘flipped’; I don’t know of any personally, but it seems likely that these were unstable personalities. More research is needed; the results could prevent mishaps in the future.

Addiction A drug is considered addictive if physical withdrawal symptoms occur when a regular user stops taking it. MDMA is not addictive by this definition, and in fact has a built-in barrier against frequent regular use — it rapidly produces tolerance while providing more side effects. Whereas you can get drunk every night on alcohol, MDMA soon ceases to work. The pleasant effects become less and less, and after less than a week’s daily use of MDMA they disappear completely

while the amphetamine-like effects increase.*’ It is then necessary to stop taking MDMA for several days before you feel good on it again, and to get the full effect may take several weeks. Frequent use is almost unknown in the States, where Ecstasy has been noted as unique among recreational drugs in that it is not taken repeatedly. However, many British users do, in fact, take MDMA every weekend and try to overcome tolerance by increased doses while putting up with the poor quality of the effects. There are many regular users who rely on Ecstasy to make them feel good, and who feel depressed and lacking in motivation except while enjoying its effects. Others simply find that life is dull except when they are on it. I have even heard of a man who can only

function normally when he is on Ecstasy.” Most hard drug users do not like Ecstasy.”” However, the Drug Enforcement Administration in the US carried out experiments which they interpreted as indicating potential for abuse: they found that cocaine-addicted monkeys would ‘reinforce themselves with MDMA’.”?

45

46 the dangers of Ecstasy — risk of death

Overdosing The effect of taking several Es at once is to produce an amphetaminelike effect — “a jittery, anxiety-provoking high”. Some users take Ecstasy specifically to achieve this sort of effect, but they are said to be switching to amphetamines.’ It is likely that taking large and frequent doses is bad for you”, although one man is said to have taken 42 tablets yet only suffered a hangover*!, and a personal account is included of a

woman who says she survived taking 100 at once.4Pp"**? Although there is no specific evidence

that overdoses

cause

permanent damage, there is certainly a high risk that they do.’* ® This may perhaps be reduced by taking vitamins.*

Can Ecstasy use lead on to other drugs? Ecstasy and opiates have little in common, hence junkies do not find that MDMA satisfies their needs.”° Social workers with a broad experience of drug users believe that it is unlikely that MDMA users will go on to addictive drugs because junkies are a separate social group.” Rather than being regarded as romantic anti-heroes, the typical

Ecstasy user sees them as “old and smelly’’, and is strongly antiheroin.”? However, there is some evidence that MDMA users are more likely to go on to take hallucinogens.*:® And Ecstasy users do generally take other drugs such as Amphetamine, LSD and cannabis.”

Risk of death There are two ways of looking at the risk of death from taking a drug. The first is to compare the total number of people who have died with the total number of doses taken. This gives you the risk ofdeath ber dose, such as one ina million. The second is to compare the number of people who have died in* a year with the number of people who consume the drug. This gives the risk of death per yearas a result of taking the drug. In both cases, two figures are needed: the number of people taking the drug and the number of deaths resulting. These are examined below.

How many deaths are due to Ecstasy? Surprisingly, this is not easy to answer. The official Home Office figures are so out of date as to be useless, although officials guess that the present total figure is somewhere between 10 and 20.8%! The National Poisons Unit put the present figure of known confirmed Ecstasy-related deaths at 14 for the period January 1988 to

the dangers of Ecstasy — number of deaths

July 1992.* These are fatal cases where MDMA was found in the victim's blood or urine, but it is not necessarily implied that MDMA was the cause of death. The list is not comprehensive. Newspaper reports up to March 1993 blame Ecstasy for the death of 17 to 22 people®, but these figures cannot be trusted. The main reason is that ‘Ecstasy-related death’ is often mistakenly taken as meaning that MDMA was the cause of death, rather than that the victim was known to have taken MDMA but the cause had not been established. Even the ‘quality’ newspapers and medical journals cannot be trusted (see chapter 7). In the USA, an examination of the deaths of five people who had taken Ecstasy showed that other potentially lethal medical factors played a major part. Although MDMA was found in the victims’ blood when they died and may have contributed to their death in some unknown or indirect way, in four cases there was an explanation for their death which was not related to taking MDMA.* The fifth death

may also have been due to other causes.” An organisation called DAWN (Drug Abuse Warning Network, part of the National Institute of Drug Abuse) collects reports of illicit drug use from hospital casualty departments all over the United States.” Whenever someone turns up at an emergency room and a drug is involved, either found on the person or in their blood or urine, or even if a patient comes in with a problem and mentions that it is drugrelated, a report is sent to DAWN besides reports from post-mortem examinations when drugs have been detected. These reports are analysed and figures are published for all drugs that are reported over 200 times in the past year. Although 138 drugs are listed, Ecstasy has never been included. DAWN publishes a separate list of drugs that have caused more than 10 deaths, but again Ecstasy is not included. The figures imply that there is no general medical cause for concern over MDMA use: though there are mishaps, these are rare. Indeed, there are well over a hundred other drugs that cause more problems. Even if the number of problems due to MDMA were increased in proportion to usage in Britain, there would still not be a significant number. In conclusion, it seems likely that, apart from very rare incidents, the deaths in Britain as a consequence of taking MDMA is limited to those who died of heat stroke, of which 14 cases are known to date.

The worst annual figure was that for 1991 with seven confirmed Ecstasy-related deaths known to The National Poisons Unit.” The number of people in the UK who take Ecstasy has been

47

48 the dangers of Ecstasy — long term effects

discussed in Chapter 5. An educated guess is that the number lies between one and five million. How often users take the drug is also open to guesswork. A London survey showed that a third of users took Ecstasy at least once a week, while a minority binged on 10-20 over a weekend. This would imply that average usage among this sample was somewhere in the region of 25 a year, although this may not be typical. Taking the worst figure of seven deaths in 1991 and assuming there were only 1 million users, the risk of dying from using Ecstasy would have been 7 in a million or 1 in 143,000 per year. If users take an average of 25 Es a year, then the risk of death on each occasion is 7

in 25 million or 1 in 3.6 million. To put this into perspective, if you take five rides at a fun fair you

run a risk of 1 in 3.2 million of being killed through an accident.* Some sports are obviously dangerous, such as parachuting which kills 3 in 1000 participants per year. Even skiing in Switzerland is risky — 1 in 500,000 are killed.™ If you play soccer, every year you mun a risk of 1 in 25,000 of being killed. But if you stay at home instead of going out you still aren’t safe, since the risk of being killed through an accident at

home is 1 in 26,000 a year!?¢ Many prescription drugs carry a high risk, including some you can buy over the counter without prescription. For example, over 200 people die from taking Paracetamol in Britain each year, more than ten times as many as die from MDMA.” Many people will argue that these figures are meaningless as they are based on guessed statistics. Suppose the figures distort the results ten times over, the risk of dying through taking Ecstasy is still smaller than taking part in a wide range of acceptable activities. It has been said that more people would die if alcoholic drinks replaced Ecstasy at™

raves.” Moreover, if ravers and organisérs took the appropriate steps to avoid overheating the risk would be negligible.

Permanent damage to health It is often argued that MDMA has never undergone the rigorous trials demanded of a prescription drug, and therefore carries more risk. The counter argument is that MDMA has been tested by many millions of people over the past twenty years, and that this is a far more stringent trial. It is true this has been done in an indiscriminate way and without controlled conditions, but with such an enormous sample, evidence should have come to light by now if the substance is toxic. Since it has not, it seems fair to conclude that, although there may be unknown

the dangers of Ecstasy — social dangers

damage caused, the risk is no greater than taking a new prescription drug.

Temporary damage to health Taking Ecstasy often causes fatigue simply because of the increased metabolic rate — the body and mind ‘live faster and you wear yourself out. To this must be added fatigue caused by whatever you are doing on E, such as missing a night’s sleep, dancing for hours on end and not eating. Taking booster doses or any other drugs cause extra fatigue®, and the exhaustion due to two drugs taken together may be greater than adding the effects of taking the drugs separately. Again, for people who are not healthy this extra exhaustion could affect them badly, and for someone on the verge of being ill this might be the ‘straw that breaks the camel’s back’. There are also indirect dangers of taking Ecstasy. These include taking something else you thought was MDMA and taking depressant drugs to reduce the effects of taking ‘too much too often’.” One study has put the risk of ending up in the casualty department of a hospital at 23 per 100,000 rave attendances. The majority of the sample studied discharged themselves after being given treatment for racing hearts. None of those who had taken Ecstasy alone needed further treatment, the rest having taken a variety of other drugs at the same time. This compares to the risk of injury while on a skiing holiday in Switzerland, which is 3% or 3,000 per 100,000.

Catching colds and other infections It’s often said that taking Ecstasy affects your immune system, making you more likely to catch a cold afterwards. I have not found any evidence to support this, but it is common medical knowledge that you are more vulnerable to disease when you are exhausted, and that a hot sweaty environment is ideal for transmitting viral infections.” Add to this that many people make skin contact while on Ecstasy, and it is not hard to see that while MDMA may not affect the immune system, its use may indirectly make you more susceptible to colds and other infections.

Social dangers A very real danger of taking Ecstasy is that you may do or say something

you will regret, or that will upset someone else. This may be trivial, such as embarrassing some member of the public by your lack of inhibitions, or as serious as causing an irreparable rift; for instance, by

49

50

dangers — social

telling your father that you have never respected him. There is also “a tendency to call up ex-lovers and casual acquaintances and tell them how much you love them”.’ Another danger is ‘inappropriate emotional bonding’, by which is meant falling in love with the person you are with,® although the same source also claims that “whatever you choose to create will be a perfect and appropriate choice.” Acting on impulse while under the influence can also be a mistake — although insights can be made on Ecstasy, so can mistakes.* A quite different kind of danger is that using Ecstasy makes people into criminals just as happened with drinkers under Prohibition in the USA, and reduces their respect for the law.””°

of

The Law

n the seventies, there was concern about a new type of drug, hallucinogenic amphetamines such as MDA and MDMA, which had not yet reached Britain. With a tradition of being more prohibitive than other countries, the British government tried to forestall trouble by classifying the entire chemical family as Class A drugs; the most restrictive category carrying the highest penalties. This was effected through the Misuse of Drugs Act 1971 (Modification) Order 1977 (SI Number 1243). So, although prohibition dates from 1977, MDMA is a

controlled drug under Class A of the Misuse of Drugs Act 1971. Class A includes all compounds structurally derived from an N-alkyl-amethylphenethylamine by substitution in the ring with an alkylenedioxy substituent, and this includes MDMA and its salts. Parliament may move drugs to other classes after consultation with or on the recommendation of the Advisory Council on the Misuse of Drugs, whose purpose is to keep under review the situation in the United Kingdom. The British government is a signatory to the International Convention on Psychotropic Substances which requires member nations to make laws to control specified drugs. In spite of objections from the chairman of the Expert Committee, the Convention issued a directive to outlaw MDMA in 1985, but “urged countries to use the provisions of article 7 of the Convention on Psychotropic Substances to facilitate research on

this interesting substance.” Although the British law against MDMA was made before this, the Act does allow for Class A drugs to be used for research.”

Penalties The maximum penalties that may be passed by any court for drugs offences are set through legislation. Courts have a wide discretion on what penalty to impose provided that they do not exceed the maximum. They must act judiciously and not arbitrarily, and they must take note of the Court of Appeal’s guidelines. It may be possible in practice to persuade a court to pass a lighter sentence for an offence involving MDMA than the court would have passed had a quantity of heroin of

52

the law — penalties

the same value been involved, but the Court of Appeal has always held that no distinction should be drawn between the various types of Class A drug, it being for Parliament (as advised by the Advisory Council on the Misuse of Drugs) and not the courts to classify drugs. For offences involving Class A drugs, the maximum penalties are as follows: 1. Life Imprisonment and/or unlimited fine for production, supply, offering to supply and possessing with intent to supply besides confiscation of assets (except for assets that you can prove were not the result of supplying drugs). 2. Fourteen years imprisonment for allowing premises to be used for producing or for unlawful prescribing 3. Seven years for possession. For any of these offences, the Crown Court has power to impose an unlimited fine in addition to or as well as imprisonment. Ifamagistrates’ court hears the case, the maximum is six months’ imprisonment and/ or a fine of up to £5,000 for any offence in relation to Class A drugs. All courts have power to impose sentences such as community service or probation instead. The Court of Appeal’s guidelines (as laid down in the Aramah and Bilinski cases) for offences other than simple possession involving Class A drugs are, briefly: 1. Fourteen years for importation involving a street value of over 41m 2. Ten years for importation where the street value is between £100,000 and 1m 3. Four years for the importation of any appreciable amount 4. There may be a considerable reduction in penalty if there is a confession of guilt coupled with considerable assistance to the police 5. Three or more years imprisonment for supply.

The Magistrates’ Association sentencing guidelines suggest a fine of 30 units for possession of a small amount of a Class A drug in contrast to a Guidelines fine of 4 units for the possession of a Class B drug. The value of a unit depends on the offender's means and can be between &4 and £100. 30 units represents a fine of between £120 and £3,000. When someone is found in possession of more than a “small amount” of a drug (which is not defined), the guidelines recommend a community sentence, custody or committal to the Crown Court for sentence, Precursors (chemicals that may be used to make MDMA) are controlled under section 12 of the Criminal Justice (International Co-

the law — possession

operation) Act 1990 which was enacted following the signing of the Vienna Convention Against Illicit Traffic in Narcotic and Psychotropic Substances. This makes it an offence to manufacture or supply a scheduled substance knowing or suspecting it to be used in the unlawful production of a controlled drug. The maximum penalty for this offence

is 14 years imprisonment.

How the law is applied The way you will be treated for a drug offence depends on whether you are considered to be a dealer or carrying drugs for your own use. Dealers are charged with ‘supply’ or with ‘possession with intent to supply while users are charged with ‘possession’. However, you will be considered to be a dealer, and charged with supply, if you pass on drugs to other people. It makes no difference whether you have made a profit, or if other people asked you to obtain the drugs for them. Even a gift to a friend of a single tab of Ecstasy makes you guilty of ‘supply’. The fact that MDMA is a Class A drug means that you will probably be given a higher sentence than you would for a Class B drug such as amphetamine — particularly if you are accused of dealing.

Possession If you are caught by the police with one or two pills, what happens to you depends very much on chance. The luckiest outcome will be if the police happen to be overloaded or concentrating on arresting a gang, when they may just confiscate the drugs and let you go. Normally, they will arrest you and take you to the police station. About half those arrested for possession are simply cautioned® and let go, and this is more likely to happen in a big city, particularly London. You are also

more likely to be cautioned if it is your first offence, if you have nothing else of a suspicious nature on you and if you look innocent. You can only be cautioned if you admit the offence (such as that you were in possession of an illegal drug). In Scotland, cautions are seldom given, but, if found guilty of possession of a small amount and you have no previous convictions, you stand a good chance of ‘admonishment’ — no penalty on this occasion, but more severe penalties on a further offence.

Fines are applied following the unit system; the decide on what fine to give in terms of a number of out the fine according to your ‘disposable income’. depends on luck, with small country courts giving the

court first has to units, then work However, a lot

highest penalties

whereas elsewhere fines as low as £15 are not uncommon. For second

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54

the law — searches and warrants

offences, the range is about £25 to £130 and increases with further previous offences. People caught with other drugs on them or who have committed other offences are likely to face heavier fines or imprisonment.

Supply If you are charged with supply, your case will almost certainly be heard at a Crown Court. Imprisonment is the usual penalty on conviction unless your barrister persuades the court that you are not a dealer but simply supplying friends. Sentences vary from 18 months to 5 years in most cases; again, chance plays a big part. Besides the quantity, being found with several different kinds of drug or a lot of cash will go against you, so will evidence that you were seen trying to sell drugs or that someone suffered as a result. Image counts too — if the court sees your trade as part of a ruthless operation rather than that of a naive individual, then you are in trouble.

What to do if you are arrested Do not resist, make notes of exactly what happens, and ask for a solicitor. If you cannot make notes on paper, then memorise events as best you can until you have the chance to write down what happened. The reason for making notes is that the police quite often make mistakes in procedure which can be used to your advantage by your solicitor. Resistance may be interpreted as implying guilt, and you may also be charged for another offence. Assistance froma solicitor is free to suspects held by the police, but you may have to wait in a cell, sometimes for a long time. The advantage is that a local solicitor will know the police and will be able» to give you the best advice. This is particularly useful if the police are trying to strike a deal with you. This is quite common. A typical offer might run: “You confess that the pills are Ecstasy, and I'll ask my supervisor to caution you and that will be the end of it’. The pledge will usually be kept, but it has been known for suspects to be double-crossed. Once you have confessed, the policeman may come back and say, “Sorry, but my boss has decided to charge you all the same”. The underlying reason for this is that if you confess, the police need not have the drug analysed, which can take up to 3 months.®?

Searches and warrants Warrants. If the police arrive with a warrant, read it, ask for a copy

the law — police policy trends

and note what they do on your premises. Don’t resist, the only way you can help yourself is to co-operate but object to any incorrect procedure later. Search The police must have ‘reasonable cause’ to search you, and that does not include the mere fact you were in a place where drugs were on sale. Ask what their reason is for searching you and note what they reply. If the reason is not good enough, then the evidence so obtained should not be used against you. Searches may include a strip search. An ‘intimate search’ is only admissible if there is reasonable cause to believe you are supplying Class A drugs — intimate search is not allowed with people who are suspected of possession. Possession suspects who are subjected to an intimate search could charge the police with assault, or with indecent

assault if the police search the genitals or anus. ‘Intimate search’ means looking inside any part of the body, including the mouth and ears.

Blood and urine tests You cannot be compelled to give samples except in traffic cases. However, the fact you have refused to give a sample may be used as evidence against you.

Police policy trends There is a trend towards giving cautions instead of prosecuting for the possession of drugs; but this seems to be mainly due to pressure on police testing facilities.°° What is worrying is that there still seems to be no recognition in Britain that MDMA is far less dangerous than heroin, for instance, whereas in Holland there has been a recommendation to

move MDMA to a lower category.” Another worrying trend is that there is a movement within the police to turn attention to users rather than dealers.” The idea — expressed by Commander John O’Connor of the Metropolitan Police in a recent report — that the policy of arresting dealers has failed and should be replaced by a drive on arrests of users, would involve thousands of arrests. It also conflicts with recommendations of sociologists in the field.** However, the lack of resources may prevent this from becoming policy. I was also worried by the lack of interest in harm reduction on the part of the policemen I interviewed. I feel that it would earn the police a great deal more respect if they were seen to show some caring for ravers instead of being seen as persecuting them.

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8

Ecstasy and the media

A a government sponsored conference on drugs, the TV and radio presenter Nick Ross was asked whether he thought the media got the right type of message across to young people.” It depends what you mean by the right type of message. I think it puts a very antiseptic message across. I suppose if we were to tell

the truth, we would point out that many drugs are fun. They give you an extraordinary

sensation of exhilaration,

of excitement,

of

energy, of capacity, calmness, insight, escape, relief and pleasure — above all, pleasure. That's why so many people take them. Again, if we take a less antiseptic approach we would say that very, very, very, very, very few youngsters who get involved with drugs will become addicted to them or have serious problems with them. Far more of them will die or become seriously injured through road traffic accidents. But you wouldn’t allow us to say that. And I’m not sure that being honest is really what society asks of the media. I think that what we are being asked, under a rather fraudulent umbrella of being candid,

is to carry a PR message. My experience of doing programs in this area is that the closer you get to the street and the more you talk to people who actually work in the area, the less concerned they are to hear this PR message and the more they want us to say the sort of things that, at the moment, I think we fail on. We are not saying some of the true things. Remember that the constituency of drug users is a very broad oney We are not just talking to the one person who has one view of life.

We are talking to millions of people almost all of whom

have

dabbled with addictive substances. Not only the substances that are illegal, but the substances which are legal. This is the complexity of it. I'm not sure society wants us to talk about it all that elaborately. It likes the simple message: ‘Drugs are there, they are bad, they are criminal and you shouldn’t go near them’. I think that we do that message pretty effectively. It is easy to justify this position by saying that the government made Ecstasy illegal to protect its citizens. The argument goes: ‘We, the responsible media, should not encourage people to break the law or harm themselves. However, there is a lot of interest in the subject, so we must report it. Therefore, we will edit our material so as to cut out

Ecstasy and the media

anything that might encourage people to break the law.’ This may sound alright, but the fact is that you cannot tell the truth when you leave out one side of a story. Press scare stories Even the ‘quality’ newspapers and medical journals do not report on Ecstasy fairly. In October 1992, The Scottish Medical Journal (and later The British Medical Journal published an article entitled ‘Ecstasy and Intracerebral Haemorrhage’, where a case is described in which a 20year-old man died after ‘his drink was spiked with Ecstasy’.* As the symptoms were not typical for MDMA, I wrote to the author of the report asking how much MDMA was found in the patient. He replied: “Unfortunately no assays for MDMA or related substances were made in any of our cases.” In other words, he had done no tests and had no hard evidence that Ecstasy was involved at all. Despite the lack of evidence that MDMA was involved, the case was picked up by the Glasgow Heralds medical correspondent, who reported under the headline Highlighting the dangers of Ecstasy. The article had an authoritative tone and stated unequivocally that the cause of death was Ecstasy, while implying that the drug was known to cause serious brain damage. The article mentioned an “epidemic of use” and referred to patients in psychiatric care as a result of taking Ecstasy, inferring that psychological damage was due to a similar physical cause.

The Times In October 1992 The Times commissioned me to write a front page feature on Ecstasy for the Saturday Weekend Times. 1 warned the editor that my conclusions were likely to be far more positive than any that had so far been published, and made it a condition that I would only go ahead if I could be sure that the piece would not be edited in a way that altered the sense or made me look silly, and the section editor, Jane Owen, agreed. I was very pleased as I felt sure that a positive article in The Times would carry considerable influence. I put a great deal of effort into the article, and, after some agreed changes, I was told that the editors were very pleased with it. It was a serious article addressing the question of toxicity based on references to the latest research, and concluded that the case against the drug is not proven. Yet it was never published — the paper seemed more concerned

with not upsetting

publishing the truth.

their Establishment

readers

than

57

58

Ecstasy and the media — The Times

Then, shortly after my article was due to appear, The Times included the following piece by Dr. Thomas Stuttaford in the Medical Briefing column: A thirst for Ecstasy Ruthless rave promoters are allegedly restricting the supply of water to dancers rendered overpoweringly thirsty by the drug Ecstasy, so that the revellers may be persuaded to buy more costly drinks. At the same time, it has been reported that several would-be nannies

have been sacked from the Norland Nursery Training College for experimenting with the drug. Both ravers and emergent nannies should read the British Medical Journal editorial by Dr. John Henry, consultant physician at Guy’s, on the pharmacology of Ecstasy, a drug first patented in 1913 as an appetite suppressant — and rejected for this purpose. . . This was particularly annoying as my article had contained the following: Dr. Henry of the National Poisons Unit at Guy’s Hospital, London, the researcher most quoted in alarmist reports, has been accused by one of his own sources of a misrepresentation of the facts. In a recent article in the British Medical Journal (MDMA and the Dance of Death), Dr. Henry claims that MDMA has no therapeutic potential. To support his argument he refers to a study by Dr. Greer where 29 volunteers were given the drug by psychotherapists and “All 29 experienced undesirable physical symptoms. . .” including nausea, stiffness and sweating. In a letter in last month’s BMJ, Dr. Greer accused Dr. Henry of omitting the positive results of this study. “Eighteen of my subjects reported positive changes in mood after their session; 23 reported improved attitudes . . . Subsequently, I offered the article to all the ‘quality national daily papers, but each one refused it. Eventually, it was published in Druglink® a ‘trade’ magazine for workers in the field. Though few people will have read it there, I felt validated in that the editor satisfied himself of

its accuracy by checking up on the many references made to published

scientific papers. I believe that the problem with my article was that it blew the gaff on the scare stories. The media revelled in news of tragedies but simply did not want to know the good news.

9

Psychotherapeutic use in Switzerland

€ most extensive use of MDMA in psychotherapy has taken place in the USA. However, when the US government outlawed the drug in 1986, this practice came to an abrupt halt. The US Drug Enforcement Agency also requested the World Health Organisation (WHO)

to include

MDMA

in the International

Convention

on

Psychotropic Substances and so make the ban world wide.* The WHO appointed an Expert Committee to make recommendations to member nations, and these included a recommendation to follow up

preliminary findings that MDMA had therapeutic potential.° Although Switzerland is not a signatory to the Convention, the Swiss government was impressed by this clause and decided to be guided by its recommendation. In December 1985, a group of psychotherapists in Switzerland obtained permission to use psychoactive drugs in their work including MDMA, LSD, Mescaline and psilocybin. They formed The Swiss Medical Society for Psycholytic Therapy”, and besides treating patients with these drugs, members take one of the drugs together at twice yearly meetings. The word ‘psycholytic’ means ‘mind-dissolving’. Originally five members, all fully qualified practising psychotherapists, were licensed to use the drugs with their patients, and they were allowed a free hand without government interference until the summer of 1990, when a patient died while under the influence of Ibogaine, the psychoactive root of an African plant. Although Ibogaine was not illegal, the therapist involved was severely criticised for his conduct: he had administered the drug in France, where his license was not valid, and he had failed to screen his patients for health problems. The incident was a disaster for the Society: all its members were subsequently banned from using psychoactive drugs. After a year and much diplomacy, permission was restored for the remaining four therapists to use MDMA and LSD, but with severe

restrictions. They were only allowed to use these drugs with existing patients until the end of 1993, and under the observation of a professor at the University Hospital in Basle. The professor has made it clear

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that, although the therapists appear to have treated many patients successfully, their reports are regarded as anecdotal because treatment has not been conducted within the context of a scientific study.

Comparative study This has prompted Dr. Styk to plan a comparative study examining whether psycho-therapeutic treatment is more successful if it includes the use of psychoactive drugs. If the results of this study are positive, he will use them to support his application to extend licences: The study will compare two methods of treatment: ‘meditative’ therapy combined with psychoactive drugs and breathing techniques combined with body work. Dr. Styk intends to use as subjects patients suffering from lifetime depressive neurosis, obsessive-compulsive behaviour and, possibly, eating disorders; conditions for which he believes treatment with MDMA and LSD is particularly suitable. He will take on twenty patients of each type and treat them all himself, using a random method to select the ones to be treated with and without drugs. He will then study and report on the progress of both groups for one to two years. In addition, Dr. Styk will also present the authorities with a dissertation on past case histories. This is being prepared from the licensees’ notes by a psychiatrist who has not used psychoactive drugs in his work. Dr. Widmer believes a more confrontational approach to licence renewal should be taken. Rather than trying to appease the authorities, who he believes make their decisions on political grounds rather than clinical results, he wants to carry on giving treatment in whatever ways he sees fit. He originally persuaded the authorities to give their permission by being pushy, and he believes that a combination of insistence on being able to practice with LSD and MDMA combined with keeping on friendly terms is likely to work best. However, Dr. Styk also acknowledges that the decision as to whether to extend the licenses depends on factors other than the effectiveness of the treatment, such as whether giving approval might benefit or damage the careers of the officials who make the decision. In January 1993, I attended the Society’s annual dinner where I met about 30 members. | interviewed each of those licensed to practice at their place of work over the following few days. Of the four licensees, only one, Dr. Bloch, uses MDMA on its own. I have included my interview with her in full, as it is the one most appropriate to this book and, I believe, gives a clear picture of how MDMA is used. Both Dr, Styk and Dr. Widmer also use LSD, and Dr.

psychotherapeutic use in Switzerland — interview with Dr. Bloch

Widmer runs a training group for psychotherapists who want to learn the techniques. I have included notes on the differences between the way they work and Dr. Bloch. The fourth licensee, Dr. Roth, has stopped using psychoactive drugs, and I include his reasons for making this decision. I also mention the activities of some of the unlicensed members who I met at the dinner.

Interview with Dr. Bloch Dr. Marianne Bloch graduated in medicine in 1970, then went on to

train as a Freudian analyst in the USA from 1974-76. From 1976-80 she trained as a child psychiatrist in Luzern, and since 1983 she has had her own private practice treating adults. Over the period 1980-90 she was trained in Organismic Body Therapy by Malcolm Brown. Over the past decade she has herself tried various psychoactive drugs. Do you use LSD as well as MDMA?

No. Although I have permission to use LSD, and use it for myself, I have decided only to use MDMA with patients. LSD lasts too long, both for the patient and myself. In my own experience, I like LSD much better in a one-to-one setting. I don’t like LSD in a group, and therefore I don’t want my patients to use it in a group either. What is the problem with using LSD in a group? I become too sensitive. There were too many stimuli for me — I guess it depends on one’s personality. The more I was able to allow things to come through, the more difficult it was for me to handle them. In a one-to-one setting it was OK, but I don’t want to do it with patients. Do you do individual work with MDMA or just group work? I do both. Mostly I use MDMA in a group, but when there is a patient who needs complete attention I use it individually. When did you start using MDMA with clients? In 1989. At first it was with single patients, then later with groups. What are the particular advantages of using MDMA? For instance, is there a particular character type or problem that it is suitable for? Is it perhaps only suitable when clients reach a block? I use it with patients who are in an intense psychotherapeutic relationship with me. I usually start after six months or a year of ongoing therapy. Most of my patients come every week for individual therapy, and monthly to my Grof holotropic breathing weekends*. Among them are a few who I select for MDMA therapy *Stanislav Grof has developed a method using hyper-ventilation and music to create

an altered state of consciousness similar to that experienced under LSD.

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as well. These are mostly patients who have difficulties with their feelings — even with the breathing work and body therapy they don’t get deep enough into their feelings. So they are mostly character-armoured people. Aren't all patients character-armoured people? Yes, but there are some who have much weaker armour. For instance, oral people*. Their armouring is not as hard to get through.

So you use MDMA with the people with the hardest character armour. Yes, I prefer to work with MDMA with people who have very hard character armour. These are, for instance, women

with bulimia

and some compulsive characters and depressive patients. Are they extreme depressives? I would say moderate depressives. And then there are the most rigid people who have difficulties in contacting their feelings. Mostly they had some symptoms beforehand but then during therapy, I mean body therapy, the symptoms went away. They are left with hard character armouring which prevents them getting to their feelings. What about other groups such as people who have suppressed a memory of a trauma? Yes, that is another group. For instance I had a woman patient whose problem was Bulimia, but then it came out that she was abused by her father, although she had no recollection of it beforehand. With MDMA she said “Oh, there is some incest problem” and I was very surprised as she had not mentioned it before, and now with the MDMA it comes out clearer and clearer. This person is completely out of her body, how shall we say it, yes completely detached from her body feeling and her emotional feelings. ” Does the MDMA help her to become more integrated? Yes, it helps a lot. It's the method that helps her most to integrate and to get into her body. She is much less armoured in normal life than she was before, but she is still armoured and this blocks her from feeling her body. Very often she says “I can’t feel my legs” but on MDMA she says “I feel good, I can feel my body”. It seems to have something to do with energy flow. Ifyou had not used MDMA with this client, presumably she would have made some progress just with the body work, massage, touch and expressing emotions? *Oral people are those whose early needs have not been met adequately. They tend

to have a feeling of emptyness which they try to fill by the attention of other people.

psychotherapeutic use in Switzerland — interview with Dr. Bloch

Yes, but I am not sure that I would have come to that deep knowledge about her background, the incest problems with her father. It was so deeply covered, she had no idea it existed. Did it take a long time to come out? Was it in the first MDMA session? It was in the second. She had MDMA sessions alone because she was so frightened, and later she had sessions in the group. How often do you run an MDMA group? Twice a year. That is very infrequent. Is that a policy or is that because it takes so much time? I decided that because of the toxicity patients should not take it more than four times a year. Now that new research shows that MDMA is not so toxic, do you think you might give it more often? No, for me it is enough. Actually I don’t want to use more drugs than I have to. I also get results with breath work and body work. With some patients, these methods work well. It is the hard core ones who sometimes need a push. With what proportion of your clients do you use MDMA? In 1990 it was forbidden and we were only supposed to complete

our therapy with patients who had already been given MDMA. I strictly follow this ruling. There are only six patients now who continue and I am not allowed to use it on new patients. I have done MDMA sessions with 20 patients. Eleven of them could have continued, but only six really wanted to continue, so now I continue the treatment with these six. I don’t use it as much as my colleagues, since I want to use the least chemicals possible. Why did only six out of eleven patients want to continue using MDMA?

Two of them had become pregnant, and so could not continue. One thought that the holotropic breathing work had brought her

as much benefit as MDMA, and decided to do without taking chemical substances. Another felt that MDMA opened her up too quickly and this frightened her. She too preferred the holotropic breathing sessions, where she had more control over the process. The last found it difficult to integrate the MDMA experience into everyday life, which, I believe, requires a certain intellectual capacity.

After discussions with this patient, we discontinue the MDMA treatment.

decided

together to

Have you written any papers on your work?

No, Iam not a paper writer. I recently gave a speech at the Luzern

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psychotherapeutic use in Switzerland — interview with Dr. Bloch

Psychiatric Association. But I just like to do my work. Before the restrictions were put on, how many people were there in your MDMA groups? Twelve. I didn’t want to take more. And I always work with my colleague, another woman therapist. Widmer told me it is important to have a male and female therapist present in a group.

Yes, I think it would be better to have a male and female therapist present, but it just happens that my colleague who trained with me in psychotropic medication is a female. I did have problems with a man client — his problems had to be thrashed out with a man. It was very clear that I, as a woman, couldn’t get to him any more, he needed a man. So he had to switch to a male therapist, because he needed a father figure with whom he could continue the therapy. What doses do you give people? 125 mg. You don't vary the does according to body weight? Earlier, yes, there were some small patients and they got 100 mg. Do you find MDMA is much stronger for some clients than others? I don't find so much difference, no. Some take a longer time to get into it.

Do you give it in one dose? Yes: Do you take it yourself, or does your assistant? No.

When you do the group work, can you describe how you do it, how formal tt is, ifyou have any ritual attached to it? We meet at 8 o'clock in the morning. We all sit around in the circle; say how we are feeling at the moment; if we have any news; how we feel about taking the drug. Of course these people all know each other because they have taken the drug several times together and go to the monthly breath workshops. They really don’t have to introduce themselves any more. Then we do some meditation. We sit there in a circle, breathe and go deep into ourselves. It’s like Zen. Then after a while my colleague starts playing the Monochord, a string instrument with only one tone. Then they take the drug. Do you take tt in a ritual way? We just pass it round and take it. And then we eat some chocolate. Ob! Chocolate?

Yes, it speeds up the effect of the drug. Really? How is that?

psychotherapeutic use in Switzerland — interview with Dr. Bloch

Albert Hoffman [the discoverer of LSD] told me about it with reference to LSD, and he said that there are some receptors that it speeds up, and now we do it with MDMA and it seems to me that it works. They always have to take their orange juice, their pills and the chocolate. I think it has something to do with endorphines. How long does it take to come on? About half an hour. After they have taken the pills they lie down and my co-therapist continues to play the monochord. Do you have any rules or agreements about how clients interact with one another or with yourself? How do you run the group? Mostly I say that the patients are by themselves. They lie on the mattresses in their space; it’s something that has to do with internal work and they have to stay by themselves. But lately I have started to say “Why don’t you mix a bit?”. Maybe they were looking around and would say “This person seems to be very sad” and I would say “OK, if you feel like going over to this person who you think is sad you can do so.” I mean, I encourage them to communicate with each other. But this is new, in the beginning I wanted to keep each of them separate, just going into their own

space. How do you deal with the situation where the person might be feeling sad but actually not want someone to approach? Do they have to ask before moving? Yes. A patient who feels they want to go over to another has to ask: “I would like to get closer to you, how is it for you? Do you want me or not?”, and the other person has to decide. I tell them that they all have to be very honest. They have to feel for themselves what they want.

Does the problem come up that you get one or two clients who draw the attention to themselves, and the others feel they have lost their opportunity? Is that a problem? Of course, this might evoke an old problem. Maybe a sibling has had more attention and now it’s a similar situation. They have to work with the sadness and jealousy that comes up. When I stay with a patient, I always watch my own feelings, because there are some people who want to draw attention forever, they want to have me forever, and I can feel in my body exactly how long it is OK for me to stay. Suddenly I get the feeling it is no longer good for me and I just go. And then the patient has to deal with the loss, not getting enough attention, that’s a very important experience.

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psychotherapeutic use in Switzerland — interview with Dr. Bloch

So ifit brings up these feelings it can be part of the therapy? Of course, it is very important that it brings up feelings of disappointment, and not getting enough, and jealousy. That’s why I do groups. Otherwise I could do it in a single session and they would have ‘Mummy’ all the time, but that is not life. Do you ask people to keep their eyes closed? Yes, when they start they mostly have their eyes closed, but later on they sit up or they talk, and can walk around to ask someone if they can get close to them. But sometimes I feel that they talk too much, so I say “You are too much outside yourselves” and then they all have to go back to their places. It just depends on how I feel the group is going. Do you allow people to be alone in another room? It depends. Very often people say in advance they will have to be in another room since they can’t be together with so many other people. I say “OK, we will see when the drug is affecting you, then we will decide.” So far I've never experienced someone who wanted to leave the group and be alone. So after people have started opening up, what do you do next? Then I play music on tapes. Mostly meditative music but also some with bass, rhythmic bass — it stimulates some feelings and activity. It's completely different to the music I use in holotropic treatment,

because there the music is actually the ‘drug’ that stimulates the activity. With MDMA, the stimulus comes from the chemical substance, so the music has a different intent in each setting. Do you use different kinds of music to stimulate people in different ways? To bring up aggression, for instance? Yes, and sometimes also anxiety.

What kind of music stimulates anxiety? It's some kind of dramatic music. "e Film music from a thriller? That’s right. But people require different stimuli. I mean, it’s not only music which stimulates feelings, but also contact. Sometimes it's very important that closeness between a patient and myself brings up a feeling of anxiety, because they are afraid of closeness. Even on MDMA? Even more so. I remember an obsessive-compulsive character who was never in touch with her feelings of closeness, and the last time with MDMA she really got in touch by being close, having close body contact and also eye contact. The first time she felt her panic by being close.

psychotherapeutic use in Switzerland — interview with Dr. Bloch

Do you use that as a technique, suggesting that people make close eye contact? It depends, it depends on the situation. With this patient it was important. The three of you who are practising using MDMA all seem to be doing body work. Do you ever do purely verbal therapy using MDMA? No, not purely verbal. As I see it, that would be to stimulate just one level. But I believe it is very important that people use the MDMA to get into the body and out of the head. There are people who only want to talk, and after a while I just cut them off and say “No more talking”. Because it’s separated from their feelings? Yes. Of course. And from their awareness and sensitivity of the body, it’s very distinct. Can you give me a few more examples of when MDMA has been particularly useful? One patient was an extreme stutterer who had been in therapy for a long time. With MDMA, she could really talk about her history for the first time — because before she was only able to write things on a slip of paper. With MDMA she spoke about her father, how she was held back and not accepted as a child, and all of her emotional feelings came up in regard to this theme. So on MDMA she was able to talk freely? Yes, it was incredible. It was also incredible how her body opened up. She started to breathe dramatically, and then sounds came out, and she could talk without difficulty. But it was also significant that after the MDMA session her stuttering came back. It was not as bad, but she continued to stutter. So MDMA

didn’t cure the stutter, but enabled her to talk about her

pain concerning her father. Exactly, and this opened up a different area that could be worked with in ongoing psychotherapy afterwards. Material came up that was not known about before. And so this opened up certain feelings. Couldn't she have overcome the problem by writing? Although she seems to be of normal intelligence, she couldn’t go to a normal school because of her stuttering. So her writing is slow and it would have taken too much effort to write everything down. Do you think that she might be able to cure the stutter through MDMA?

She is a rather difficult person to treat. In the last session with

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psychotherapeutic use in Switzerland — interview with Dr. Bloch

MDMA she used her new ability to talk in a very intellectual way. So talking became a defence mechanism against feelings that were too painful for her to admit. But we will see. Can you tell me about one of the Bulimia cases. The main theme of one of the Bulimia cases is her fear of closeness and contact with her body. The Bulimia is cured, she doesn’t eat and vomit any more. Was she cured without MDMA? Yes, after about two years of body therapy and breathing sessions the symptoms went away, but then she discovered different problems. She realised that she was not in contact with her body in normal life. Through MDMA she learned what it means to be in contact with her body. How important do you think it is for people to have guidance from a therapist to make these connections and to get in touch with feelings on MDMA? What I am thinking of is the vast number ofpeople who take Ecstasy in England, do you think they are bound to get in touch with their feelings anyway, or is the therapist’s influence and therapeutic setting necessary? The setting is important, and also a person who acts as a mirror. Sometimes I am the mirror. When I work with someone, I get in contact with my feelings and then I tell them exactly how I feel. If they have feelings which they can’t admit to or which they are not aware of, I have these feelings, and then I become their mirror. For instance, I suddenly become sad and I know, “Oh, I have no reason to be sad”. Then I know it is not my sadness, it’s their sadness and that I am feeling it on their behalf, since they are not aware of it. Then I tell them “There is something I have felt that is not mine, can it be yours?” Then the person can go into their inner

space and find out. As soon as they become aware of their feeling of sadness and express it, my sadness goes away. That is how I help them to become conscious of their feelings. Do you use a video camera or tape recorder? No, but sometimes they bring their own tape recorder. If they go on talking and talking I say “OK, you can use your tape recorder and continue, then I will listen to it later’. You don't encourage that as a technique then. Do you think recordings can be useful? For some patients it might be quite useful, yes. I have one patient who always talks a lot about his childhood memories. For him this talking is also a defence mechanism, because he doesn’t really get

psychotherapeutic use in Switzerland — interview with Dr. Bloch

into his feelings. Afterwards he forgets most of what he said,

including the important things. So I encourage him to use the tape recorder. I think it is important to mention that I don’t use any techniques in MDMA sessions. I make use of my soul, body and intuition. My main intent is to get into feeling contact with the patient and then see what emerges. Sometimes I ask a question, or give some nurturing touch; sometimes nothing. The other person always responds to my presence. Do you ask people to bring things with them to the session? Yes, sometimes I ask people to bring objects they like. One patient likes to bring stones, small things like that. Last time I asked them to bring a photo of themselves up to the age of three. This opened up the possibility to work with this period of life. With some patients I used it, others not, it really depends what they are about. I just give a suggestion and if it comes up it’s OK. What came out of that? We looked at the photos together, and then they started to talk about their early childhood, because it brought up forgotten memories of that period. It stimulated memories of that part of their life. Is MDMA useful for bringing back memories from childhood, or memories that have been suppressed because ofpain, or just generally getting in touch with feelings? All of those. With one patient I mentioned it brought back this incest problem, with another it brought back very early memories that as a child he had been sick very often, which he had forgotten. The emotional stuff of childhood came up, and he re-lived it again. Another patient realised for the first time with MDMA “Oh I have a heart, there is my heart beating. I never before could feel my heart beating” It was important for him to feel inside his body, he said “Aaaarrrh! Now I feel inside.” For others it is important to get into their aggressive feelings. It’s different for each patient. Can it be too much sometimes, the sudden getting in touch with aggressive feelings? I have never had any problems with it being too much. That leads to another question. Have you ever had problems using MDMA and wished you hadn't used it with a patient? I once had a problem with one woman, and that was when the drug was beginning to take effect. She was overwhelmed by the feeling of opening up. She was overcome by fear, and she screamed

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and yelled and then it was important that she had some body contact with me. That gave her enough support, and then she was able to go through this period of fear, and after that it was OK. After what, half an hour? It started half an hour after taking the drug, and lasted for ten minutes. It was really just when the drug started to take effect, the opening up. She was completely confused. Body contact with me made it OK. You only use MDMA with a very few ofyour clients. Apart from legal restrictions, would you still not use it on some clients, and if not why not? I would only use it with the more difficult ones. The ones I can’t really get through to using holotropic breath work. I really don’t

see why I should use a chemical drug if I can achieve the same result without it. Can you get the same result as easily without MDMA? I would say with some, yes. Is it that you believe the drug is somewhat toxic or habit forming, or by using a drug the result is not going to be as permanent? I am just against drugs. I mean, in my practice I don’t use medication unless necessary. I don’t see why I should use drugs if I can get the same result without. I can’t really say that MDMA speeds up the therapy that much. The patients who I use MDMA with are those who I have already tried treating with other methods, but I was unable to open them up so deeply. I would just be stuck, I would have to say “OK. That’s it. You have to go”. Are there some people who are so armoured that MDMA makes no difference? Or will MDMA always go to a deeper stage with them,

even when your other methods have failed? I would say there are some patients with whom I’m not using

MDMA because I’m scared they can’t handle it. What would happen if they could not handle it? Perhaps they could not differentiate between the outer reality and their inner world, or they might mix the two states. For example, they may not be able to differentiate between myself as the bad mother of their inner world and myself as the therapist who wants to help them, and fight against me. Maybe I would try it in an inpatient psychiatric setting, but not when the patients have to go home afterwards and I can’t follow them up closely. I’m not willing to do overtime. I only choose patients who I believe will be able to handle MDMA. I have my limits. I know someone who uses the

psychotherapeutic use in Switzerland — interview with Dr. Bloch

drug with far more critical patients and he invests more of his time and effort, but Iam simply not willing to do so. Going back to your groups, what happens towards the end of the session? After four and a half hours we have a break and I say, “OK, now we Can go into another room where you can have some food and drink tea. Then afterwards you can go back and lie down again.” Do people want to eat? What do they like eating? Fruit, and bread with honey. That brings them down from their altered state of consciousness into the real world again. Do they stay quiet?

Very quiet. Very often no-one talks. Then they come back and lie down for half an hour. They see if there is anything else, any further effect of MDMA. And afterwards they all have to draw a mandala, a drawing of their experience. When you say a mandala, can they draw anything, or has it got to be according to a structure? Yes, we give a piece of paper with a circle on it and say “Draw a mandala.” Of course they can also draw outside the circle. But it’s also significant who goes over the limits and who keeps within the circle. They are used to doing this following the holotropic breath work, it’s a method used by Stan Grof. Afterwards we form a circle again and they just put their mandala in the middle, and then each of the patients talks about their experience. And maybe they give some explanation of the mandala. They also bring it to their next therapy session. So what time does a group finish? Usually it’s around 5 o’clock. They go home by bus. They are not

allowed to drive. ' Is their next appointment the next time you see them? Yes. Mostly it’s within the next week, except for some who come fortnightly. When you do MDMA sessions individually, with one client, is it very different? It’s different in that the person has constant contact with me and really doesn’t have the experience of ‘mother going away. All

those feelings of jealousy or whatever produced by the group setting are missing. Of course, they may gain in other ways such as having more body contact. What sort of bodywork techniques do you use? Massage, and I give some touch, nurturing touch. I also do some

cranio sacral work with them.

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And do you get people to hit a cushion with a tennis racket, that sort of thing? I use these hard techniques only in individual body therapy sessions in order to produce a feeling state. But with MDMA I never use any hard techniques because the feelings get opened up by the drug. If a patient gets into an angry state on MDMA, then I ask them to express the feeling by movements with arms and legs on a mattress. Do you think the things that come up on MDMA can sometimes be misleading for a client? What do you mean? Well, they might have a realisation — such as the cause of some problem is that they were abused as a child or something — but actually it’s become much more important than it ts really. Perhaps they can see very clearly something that isn't right. It can happen that sometimes the interpretation goes in a wrong direction, one that is not really the cause or the real root of the problem. Do you think the real root ofproblems and true feelings come up more often with MDMA than without it? I would say yes, MDMA definitely produces more real feelings, but I would say it is still possible on some level to project. And it is so important for me as a therapist to realise when the patient is projecting. I then feel an uneasiness in my body and I have to continue interacting with the person until I feel that the problem has reached its root or the projection has been resolved. Do you think you are more sensitive to the patient as a result of your own experience with MDMA? Yes, definitely. Do you think you would be even more sensitive ifyou were taking it with the patient? = Probably. But I wouldn't dare to.do so, because I also have to be able to react in a clear way. I would never do it. However, I just realise that I have become more and more sensitive through my own therapy with psycholytic substances, and I guess this will continue, and maybe at some time I will not even need it any more because this openness might be a normal state for me. Is the intensity offeelings increased under MDMA, or does it just increase general awareness? It depends. I have one patient who doesn’t have any feelings in real life. Only with MDMA can he get into his sadness or his aggression. It’s not only the awareness, with him it’s really the

psychotherapeutic use in Switzerland — interview with Dr. Bloch

capacity to feel. He’s so stuck in real life. With someone like that, presumably he feels very good on MDMA? ‘Yes!

Is there a tendency for him to go and find it on the black market and take it at home? No, he is too straight. I couldn’t imagine him buying drugs on the black market! But as a general point, ifyou have people who only feel good on MDMA then won't it become an addictive drug for them? What do you think about that? It’s astonishing, but I've never had this problem at all. Don't any ofyour patients sometimes take drugs outside the sessions? One of my patients used to take LSD when he was younger, but he says he would never do this any more outside sessions. He is much more afraid, more aware of what could happen. No, there are no drug users among my patients. One thing that bothers me ts that, well, bodywork is not completely accepted as straightforward psychotherapy, is it, and that ifpeople are making body contact at the same time as taking a drug which is normally illegal, I can see that the picture of itfrom a politician’s viewpoint may be that it is all rather dodgy. Do you see this as an obstacle to this type of therapy becoming officially accepted? I think so, because for a psychiatrist trained in psychoanalytic therapy, well, this is really crude. Most psychiatrists are still not trained in body therapy. This is why it is not more institutionalised, besides many psychiatrists are afraid of body contact. So I don’t think they will choose this method. What sort of reaction do you have from the psychiatric community in Switzerland? They show interest in hearing about it..I would also be prepared to work with my colleagues with MDMA, but it is all too frightening for them. They are too scared to use it on themselves. Dr. Roth said he believed that MDMA was not worth using because the results didn’t justify the time and effort involved. What do you feel about that? For me it has been worthwhile with the patients I have used it on. Otherwise I wouldn't use it any more. Have you taught any other psychotherapists to use it? Are they interested in learning from you? No, I gave a speech at the Luzern Psychiatric Association, and I talked to them about psychotropic breath work and about MDMA

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sessions. They said they were interested and there was an animated discussion about psychoanalytic and psychotropic training, and about the ethic of opening patients up in such a quick way. Meditation has the goal of opening up people towards spirituality, and MDMA has a similar kind of effect, to bring people more in contact with their spiritual being. So these psychiatrists discussed whether it is acceptable to use these type of drugs for spiritual enlightenment, or only meditation. So they were more interested in the intellectual analysis of the method than actually getting involved with it. Yes, they were not interested in experiencing it themselves; they were not really interested in doing anything, only in discussing it. What do you really feel the basic effect of MDMA is? I would say it takes away fear, it takes away the super-ego of the patients — they allow themselves to feel more, to be themselves, to act the way they are; it also helps them to get more into contact with their body, into their physical body, to have more body awareness, and to get closer to their feelings. And simply to feel their needs. I mean, very often they have been totally unaware of their primal needs — needs of closeness, needs of touch, needs of

heart contact. In the groups, is the atmosphere happy, or is it mainly feeling pain? When you take MDMA the first time it’s beautiful. It opens up everything and you feel “Ah! That’s great!”, but later on it's much

more difficult for the patients because they get into their sadness, into their pain, they realise where they are closed up, that they can't open their heart. So I feel the deeper you get, the more difficult it is with MDMA. This beautiful feeling of happiness goes away and you really get down to your deep problems, and then you can work psychotherapeutically. " Have you ever come across bad effects such as paranoia? No, I never have. Perhaps because I choose my patients carefully. What about physical bad effects? Unpleasant effects that get in the way? Sometimes their jaws get tense. But it doesn’t bother them.

Do they ever suffer from difficult after-effects? One patient felt she had some energy running through her body for a while. She could not stop the energy flow, she felt nervous and restless for about six weeks. That was the most difficult aftereffect I have ever seen. Once a patient suffered for about a week from nausea.

In the

psychotherapeutic use in Switzerland — interview with Dr. Bloch

following individual session I discovered that the nausea had to do with unexpressed feelings of anger. When this was resolved, the symptoms went away. Did she have a particular character type? Do you think you could recognize the type and avoid giving the drug to them in the future? I would say she is not at all in the body. It was the first time and she couldn’t really handle this feeling of being in the body. It was so new to her, and it was stress-producing. She couldn’t handle the feeling of energy flow. Do you relate MDMA to energy flow, such as the Chinese ‘Chi’ or Reich’s ‘Orgone Energy’? As a body therapist I work a lot with energy, and I realise that with MDMA there is opening up especially of the block here [she put her hand on her heart]. It opens the chest block, then of course the energy flow is better, and it also affects the whole body. So the energy flow is liberated. And do you think MDMA works by relaxing the muscles that store the neuroses? Probably, it just opens up the blocks. Usually patients have held back feelings. When you have a block in the body it is because it is too painful to allow the feelings to flow. MDMA is able to open up the blocks because it also releases the feelings — or releases the feelings and then the blocks open, you can say it either way. So it works on a physical level in the same way as bodywork? Definitely for me, yes. But I also use MDMA because of its spiritual value. MDMA is the drug that really opens up the heart, and in normal therapy I also work with opening up the heart. That, for me, is the main goal. For me it’s not important that people are totally de-armoured, but that they get in contact with love; love for themselves. That is why I really like to work with MDMA. Do you think this is a separate effect to the release of neurotic tensions? For me MDMA is the drug that opens up the heart, and is much more specific than LSD. This is my main goal, to open up the heart and then to work from the space of the heart. So that’s the goal ofyour therapy, or do you think it should be the goal of all therapy? That’s my way. So the goal ofyour method of working is to get in touch with the heart. Does that mean helping people to be able to express love, or to feel love, to know love in a non-sexual way?

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psychotherapeutic use in Switzerland — interview with Dr. Bloch

Yes, I mean love for another person, love for themselves, love for the universe. I would say it is my way of doing psychotherapy to get them in touch with their heart. And whenever they are lost in some sort of anxiety or some sort of struggle, then I bring them back to their heart and say “Can you still feel your love in yourself?” This is just my way of binding them back to themselves. If you are in harmony with yourself, then all your neuroses just drop. If you are in the meditative state, then your problems just go, you don’t even have to solve them. I try to work so as to make these neurotic things lose their value. And they very often get in contact with this state with their first MDMA experience. “Oh, that’s how it could be. I could be open, I could be loving.” And then J tell them “Do you remember how it was on MDMA, how all the other things dropped away?” I try to get them to be in touch with their heart again and with their feelings when they have difficulties in their life. They become more centred, they have more connection with their inner self. Do you ask people to project into the future, for example if they have a particular problem with their mother, do you ask them to visualize being in that situation? Sometimes, yes. I first put them in a good state, and then I say “OK, now see how it would be confronting your mother in this state”. I've heard tt said that you can't feel love until you have learned to love yourself. Do you believe that? I think so, yes. I believe in it. That only when you are really in contact with yourself, are you open enough to let love flow out. Do you have clients in the group sessions who fall in love, or get very involved with each other? Is that a problem with MDMA? It has never been a problem. Of course in the sessions they may have very good feelings for each other, but they have never bad affairs. Maybe it’s to do with the setting. There are only two women on the group, and they are very much preoccupied with themselves and do not mix very much with the others. Do you think that people are suggestible on MDMA? Not at all. I think they see things as they are more clearly. For instance, the Bulimic client I mentioned had thought she had invented being abused by her father, buton MDMA she saw it was true. She saw it very clearly. Are there other problems with using MDMA? Perhaps patients get too close to you? The transference problem is the same as with body therapy, but

psychotherapeutic use in Switzerland — interview with Dr. Styk 77

the situation of transference becomes more clear to a patient on the drug. They can see their projections more easily. When they come up to me during the MDMA session and say, “I love you so much!”, I respond by saying, “See whether this love is something to do with you. Could it not be your newly discovered love for yourself?”

Dr. Styk Dr. Juraj Styk is president of the society and has a private practice. His MDMA groups are similar to Dr. Bloch’s, but his clients meet on Friday evenings before the Saturday session. He believes this is valuable preparation for reducing anxiety, and is especially useful for integrating new members. His wife assists him in the group, and he feels that to be seen as a couple is important when he is working with women. He also has one or two young psychotherapists assisting the group who are undertaking training with Dr. Widmer. There are usually eight to ten in his group. Dr. Styk goes around giving out the drug in ritual fashion to create an atmosphere “more like being in a church than a hospital’, although he adds that he tries to avoid being seen as either a priest or doctor who can absolve or solve problems for the clients. While waiting for the drug to come on, he plays soft music and sometimes reads poetry. He asks members to close their eyes, breathe and let go. In order to make the group cohesive, he reports what he observes, such as some members being tense. Dr. Styk and his assistants only attend to people when asked, unless they see that a client is stuck for hours on end: he prefers to allow people to go through the experience without being led. Rather than being goal-orientated, he encourages spontaneity and prefers clients to think in images. Clients are allowed to go to other rooms during the group session so as to be undisturbed, but Dr. Styk says it’s important to avoid the group falling apart through members dispersing. Towards the end of the session, Dr. Styk will ask each person to report on how they are feeling. Then the group may all go out for a walk together if the weather is nice. At other times they may do a psychodrama in which one client acts out a revelation they have just had during the session, using other group members to play roles such as members of their family. After the session, at about 7 pm, participants sit around in a circle on cushions and have a light dinner of such things as cheese, radishes

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psychotherapeutic use in Switzerland — Dr. Widmer

and fruit salad, prepared by Dr. Styk’s wife. They are not really hungry, but enjoy eating for its own sake. The situation of eating together sometimes triggers further insights. After dinner, at about 10 pm, clients go home and are asked to write a report to bring to their next individual session. Dr. Styk says he always asks the men about sexual arousal during their next individual session, and that although they may have sexual longings or fantasies, none has ever had an erection on MDMA, although they may do so on LSD. When I told him that men frequently say they have erections on Ecstasy, he suggested it may be that they take amphetamine as well, or that the Ecstasy was unknowingly mixed with amphetamine.

Dr. Widmer _Dr. Samuel Widmer has a background of experience with LSD stretching back to when he was a student. From 1973-78 he was a member of a therapy group which used LSD illegally. As a fully trained psychotherapist, he wanted to use psychoactive drugs in his work, and in 1983 he wrote to the government applying for permission to work with LSD and Mescaline. Permission was not then forthcoming, so he searched for a suitable drug that was legal. He was close to

giving up the search when he discovered MDMA in 1986, two years before it was made illegal. Dr. Widmer works with larger groups than the Dr. Bloch and Dr. Styk, up to 35 people. He believes that large groups work better, and have the advantage of spreading the cost more widely — for the same reason, he avoids individual sessions. He frequently uses both MDMA and LSD in the same session. Sometimes he uses half adose of MDMA two hours before LSD, and sometimes offers a small dose of MDMA at the end of an eight hour LSD session to provide a smooth come down. At other times, he will give 100 mg of MDMA at the height of an LSD session so as “to bring in the heart aspect.” He believes that LSD has a stronger effect on a transpersonal level, but that it has little or no effect on people who have done a lot of work on themselves and are aware of themselves. He says that working with LSD is tricky; you have to choose clients carefully to protect yourself and avoid those who make problems. By contrast MDMA is good for anyone, as it opens the heart and softens hard personalites. MDMA helps to clarify one’s situation in daily life and relationships, while LSD helps on another level with questions such as ‘Who are we? The realisation that problems stem from wider issues comes more readily with LSD.

psychotherapeutic use in Switzerland — Dr. Widmer

Asked what kind of clients responded best to MDMA treatment, Dr. Widmer replied that it was always tempting to think of the dramatic breakthroughs, but these tend to occur with clients who need catharsis. Clients who were on tranquillizers often found they could do without the tranquillizers or found they needed lower doses after treatment with MDMA. Other patients benefited by a gradual ‘maturing’ process. He said there is a category of patients who do not benefit, however, and this includes those who just want to get rid of a particular symptom without being prepared to work through it. He tries to screen out such patients. When I asked what problems Dr. Widmer encountered using MDMA, he told me that there were few problems directly involving the drug itself. However, there were sometimes problems with negative transference and with clients’ partners, who would accuse Dr. Widmer

of putting ideas into the client’s head rather than accepting that they had had an insight. Asked about trends in psycholytic therapy, Dr. Widmer told me that the effect of the drugs was to open people up to greater awareness of their personality. This leads to ‘growth work’, where clients have no major psychiatric problem but wish to develop their personality, and so improve their quality of life. Dr. Widmer has written two books on his work in German, but

which he hopes will be translated into English. Here are the outlines of some case histories from one of Dr. Widmer’s books: 1 Dr. Widmer was asked to treat a 14-year-old anorexic girl. Her father showed no feelings, and her mother hardly existed for herself, only appearing to live through other members of her family. The whole family only communicated to one another on a rational level, never expressing emotion except for the youngest son, who

the parents regarded as the ‘difficult one’. Dr. Widmer and his wife treated the girl and her parents, first in separate sessions with Dr. Widmer treating the parents and his wife treating the daughter. In spite of her young age, they decided to hold an MDMA session with parents and daughter together, attended by both therapists. During the MDMA session, father and daughter talked about their feelings for one another for the first time, while the mother

became aware of the fear she had of herself. For the daughter this was a breakthrough: having focused on the cause of her problem she accepted becoming a woman and put on weight, ending her treatment shortly afterwards. However, for the parents this was the beginning of ongoing therapy.

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psychotherapeutic use in Switzerland — training group

Dr. Widmer commented that the breakthrough facilitated by the MDMA would probably have occurred anyway, but that the drug speeded up the process.

2 A life-long alcoholic came for treatment, a sensitive man of 44. During an MDMA session, he experienced deep regression and found himself ‘back in the womb’. He felt neglected and deeply hurt, and realised that this pre-birth longing was the basis of his addiction. The insight was realised so clearly that his ‘addictive personality’ was dissolved, allowing him to build a new personality based on love. 3

An intellectual working in the medical profession came for an MDMA session out of curiosity. He did not see himself as having psychological problems, despite the recent break-up of his marriage. However,

the effect of the MDMA

was

to uncover

hidden

narcissistic feelings of which he had not been aware, including hatred for his parents. The result was that he became more in touch with himself, but also to realise that he could benefit from therapy.

Training Group Dr. Widmer runs a group for training other psychotherapists in the use of psycholytic drugs. Students all have to be fully trained psychotherapists with clinical experience, and must be in individual therapy themselves. The course lasts 3 years, and costs 6,400 Swiss Francs. In each year trainees attend four weekends plus one week, which includes 15 sessions using various drugs. They also have to assist in at least 10 group sessions with Dr. Widmer’s and Dr. Styk’s clients. Most of the students are German. The first group finished their training last August, but none of them has yet obtained permission to use psychoactive drugs in their practice. However, one is lecturing 6n the use of psycholytic therapy at Tiibingen university, although without actually using drugs.

Dr. Roth Dr. JOrg Roth is licensed to use LSD and MDMA, but has decided not to do so any longer. I went to interview him in the hospital where he works to find out why. Could you tell me about the background to your use ofpsychoactive drugs in psychotherapy? Since 1977 I have been searching for the ideal drug to use as a tool

psychotherapeutic use in Switzerland— Dr. Hess

in psychotherapy — mescaline, DMT, LSD and MDMA. Now I have found it - Chinese medicine. Did you find that MDMA doesn't work, or did it have negative effects? No, I have had some success using MDMA with major depression. I think MDMA is a good tool, especially for non-chronic problems, although it is no miracle cure — some revert just as with other kinds of therapy. I have nothing against MDMA, but in my work the output is simply not justified by the input. I always work with individual patients and the time required is too long, and that means the method is usually too expensive for the patient. And they can’t drive afterwards, so they had to pay for a taxi too. It simply wasn’t cost effective. Do all your patients have to pay the full cost of their treatment

themselves? Some have insurance that pays for part of the cost, but they have to pay at least two-thirds themselves.

Chinese medicine has the advantage that it fits in with 50minute sessions, and can result in change even without the will of the patient. Did anything else put you off using psychoactive drugs? Are they dangerous? Not MDMA. LSD can be dangerous, but MDMA is always safe. There are cases in England ofpeople becoming psychotic or paranoid as a result of taking MDMA. I do not believe that psychosis could be triggered by MDMA except when used it is used with alcohol or other drugs. I have never come across paranoia. But it’s possible there are some people who cannot metabolise it, just as there are some who cannot manage alcohol. Dr. Hess

Dr. Peter Hess is a German psychotherapist who used MDMA in 19845 (before it was outlawed) at a German hospital at Frankenthal, Mainz, where he was head of the psychiatric department. Dr. Hess said that some of his patients were very difficult to treat because they were caught in a vicious circle of low self-esteem, which they reinforced by blaming themselves. “There was a hard core of about twenty patients who failed to respond to any of the treatment available”, he says. “I tried MDMA with them, individually, and was astonished with the results. They immediately found solidity and trust

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psychotherapeutic use in Switzerland — Dr. Helmlin

in themselves and made steady progress. For most, a single dose was enough, although some had two sessions.” Dr. Hess followed the patients up for two years after administering the MDMA and, apart from three with whom he lost contact, found that none of them had had a relapse. When the drug became illegal, he tried — without success — to conduct a pharmocological study of MDMA at the University of Tubingen. He also applied to the German government for a license to use MDMA but without success. He now uses musical techniques, such as drumming, to produce altered states of consciousness in group

psychotherapy. He says the effect is similar to LSD but does not overwhelm the patient. I asked whether there were any psychotherapists using the drug in Germany. “Only illegally. There is a lot of interest but no-one has _ permission. However, I have heard of it being used by a small number of therapists.” Dr. Hess did not approve of this. “I think that is stupid: you only have to get one client going through a negative transference to report you, and your career is ruined,” he said.

Dr. Helmlin Dr. Hans-J6rg Helmlin is conducting a pharmocological study of MDMA at the University of Bern. The study involves monitoring what happens to MDMA as it passes through the body by taking blood samples. Dr. Helmlin started with a pilot study of two patients in 1992, from whom 20 blood samples were taken over a 9 hour period. In Spring 1993 he plans to conduct a more elaborate study, using blood samples taken from 6 patients on the day they ingested the drug and the following day. Dr. Helmlin has no license to prescribe MDMA, so he performs his tests on patients who have been given the drug by Dr. Styk as part of their therapy. Provisional results from the pilot study suggest that MDMA has a

‘half-life’ of six to eight hours, i.e. half is left in the body after that time. I commented that this was surprising since the effects of the drug end after a much shorter time. “Yes, it surprised me too. I can only think that there is some sort of ‘threshold’ effect whereby the drug only has an effect above a certain level”. By means of this study, Dr. Helmlin aims to provide some basic data on the drug, equivalent to that provided by drug companies seeking government approval for a product. When the full results are available, they could be used by lobbyists to overcome a common objection of governments to licensing the use of psychotropic drugs,

psychotherapeutic use in Switzerland — Dr. Vollenweider

ie that it would be irresponsible to do so as the drugs have not been subjected to pharmacological tests.

Dr. Vollenweider Dr. Helmlin also told me about the plans of Dr. Franz Vollenweider, a researcher at the University of Zurich Psychiatric Hospital. Dr. Vollenweider has been using Positron Emission Tomography, commonly known as PET scans, to study what is going on inside the brain while people are under the influence of psychoactive drugs. A volunteer is given mildly radioactive sugar compounds which enter the blood stream, and this radioactivity is picked up by the scanner. The result is that the blood flow to different parts of the brain can be monitored while someone is experiencing the effects of a drug. The person can relate their experience at the same time as the equipment indicates what is going on in terms of brain activity. Dr. Vollenweider has already done PET scans on subjects taking Ketamine, a veterinary anaesthetic, and Psilocybin mushrooms, and intends to study MDMA in the future. Dr. Benz

Dr. Emst Benz has written a dissertation, in German only, on members of the Swiss Medical Society for Psycholytic Therapy and their varied backgrounds.

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10

Other uses of Ecstasy

r large numbers of young people, Ecstasy is the drug that makes raves happen and it has been said that, for many of them, raving is one of the main reasons for living.”” Yet there are other regular users, particularly in the United States, who have only vaguely heard of raves and certainly have never experienced dancing on Ecstasy. Here are some of the ways MDMA is used:

Psychotherapy According to RD Laing, the radical psychotherapist, What scientists have always been looking for is not a tranquilliser, an upper or a downer buta stabiliser, and in the seventies Alexander Shulgin thought he had found such a drug [in the form of MDMA]. In the context of its use, among very responsible therapists in America, all direct reports, including my own, were positive.» Psychotherapists valued the way MDMA helped clients to become open and honest in a way that allowed them to have insights which

they could remember afterwards.® Yet, today, it is only a handful of therapists in Switzerland that are allowed to use it. The best account of a study of the therapeutic effects of MDMA is in a paper called Subjective reports of the Effects of MDMA in a Clinical Setting by Drs. George Greer and Requa Tolbert.* According to Greer, of the 29 subjects in his study “18 reported positive changes in mood after their session; 23 reported improved attitudes, such as towards self and life in general; 28 reported improvement in interpersonal relationships, and three of the five couples reported benefits lasting from a few days to up to two years; nine reported improvements in their working life; 14 reported diminished use of abusable substances (alcohol, marijuana, caffeine, tobacco, cocaine and LSD); 15 reported beneficial changes in their life goals; and all nine subjects with diagnosable psychiatric disorders

reported considerable relief from their problems. . .” In general, the authors conclude that “the single best use of MDMA is to facilitate more direct communication between people involved in a significant emotional relationship”. MDMA was also recommended

other uses of Ecstasy —- amateur psychotherapy

as an adjunct to insight-orientated psychotherapy, for enhancing selfunderstanding and was found to be useful in spiritual and personal growth. According to an article in the American Journal of Psychotherapy®, the effects of MDMA — heightened capacity for introspection along with temporary freedom from anxiety and depression — ‘should be of interest to Freudian, Rogerian and existential humanist therapists’. It is said to strengthen the therapeutic alliance between therapist and client by inviting self-disclosure and enhancing trust. Clients in MDMA-assisted therapy report that they lose defensive anxiety and feel more emotionally open, making it possible for them to get in touch with feelings and thoughts which are not ordinarily available to them. Psychiatrists also suggest MDMA is helpful for marital counselling by making it easier to receive criticisms and compliments. “There’s less defensiveness between us and more leeway for diversity”, observed an ex-client. Long-lasting increased self-esteem was also reported by clients. Greer says that another use is in working through loss or trauma, because the issue can be faced and accepted instead of being shut away through fear.”

Amateur psychotherapy A commonly held view is that healing can only be done by the willpower of the wounded person, and the therapist merely helps the client to see what is going on inside him or herself. If someone can use MDMA to gain the same insights and to retrieve and face memories of past traumas, then this is a more direct approach. Representing ‘the informed lay user’ Robert Leverant wrote: The therapist is only the personification of the healing aspect within each person. If an individual can tap this force directly from time to time, why not? If by ingesting MDMA, a person can put ona therapist’s thinking cap for a few hours and see him/herself with new vision that is presumably empathic to him/herself, why not?” Interestingly, Freud was in favour of lay therapy and wanted to protect analysis from both physicians and from priests (Bettelheim 1983). In fact, he envisioned a profession of secular ministers of the soul, perhaps akin to PhDs. One can only surmise why the founder of psychoanalysis wanted to keep his child out of the hands of physicians and priests. One reason relevant to the drug issue is that Freud often said that all he did was reorganize in a different format the profound

insights that artists such

as Goethe,

Neitzsche,

Dostoevsky, Shakespeare and the Greek tragedians have had into the unconscious. :

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other uses of Ecstasy — amateur psychotherapy

Some people say that it really helps to have someone there for support, but that the guide does not need to be a trained psychotherapist. Dr. Roth, one of the Swiss psychiatrists licensed to use MDMA clinically, believes DIY therapy with MDMA is naive, since help is needed to make use of realisations gained, while many professional psychotherapists say that to use untrained helpers is dangerous and irresponsible. An experienced self explorer believes that people can go a long way by themselves, but wise guidance can be valuable in some situations. If you should decide to use E in this ‘self-help’ way, there are two approaches, ie with or without the guide taking MDMA as well. The advantage of both people taking it is the very close communication made possible; the disadvantage is that its hard for the guide to remain disciplined and devote him or herself to the task rather than go _ into themselves. One solution is for the guide to take a small dose, about half, as was done by Alexander Shulgin.” There are some worthwhile ground rules for such sessions: 1 The guide is there purely for the benefit of the subject and should take the part of servant and protector during the session. It is the guide’s job to prepare the venue and deal with anything that might interrupt the session. 2 The guide agrees to act in the subject’s interest, while the subject agrees to follow the guide’s instructions. Both agree to avoid sexual contact during or following the session. 3 The guide and subject should discuss beforehand what the object of the session is, and agree how far the subject may deviate before the guide intervenes. Sessions frequently take an unexpected course, and the subject should say beforehand how deeply he or she is prepared to delve into new areas during the session. 4 The guide’s job to listen but not to interpret, and to recapitulate when asked. It is also the guide’s job to intervene when the subject

deviates beyond the limits agreed beforehand. For the subject to relate what is going on to the guide throughout the session tends to keep the experience superficial, but this may sometimes be appropriate.

One example of many described in Through the Gateway of the Heart’ an American collection of positive experiences on Ecstasy, is a 32 year-old man who was at a transition point in his life and career. His aim was “to examine this transition and proceed as quickly as possible to the task at hand”. I gained an important insight into the history and development of

other uses of Ecstasy — as an alternative to psychotherapy

my personality and character. My awareness, confidence, and self assurance improved. The session provided me with one of the best opportunities I have ever had for true self-examination. I felt refreshed, vigorous, alert, and happy to an unusual degree. . . I discovered and understood with a positive and profound conviction that my identity and personality were intact. I had feared, I suppose, that I might find that I had been damaged in some irreversible way. I felt tremendous relief and joy when I learned otherwise. He added that for him, the most beneficial effects of MDMA were greater presence of mind and being able to talk with clarity. Another example given in the book is that of a woman who had been raped eight years before she took E. She had the help of two friends/guides. Although LSD was the main drug involved, she was

helped by a 65 mg dose of MDMA given 2 hours after the LSD: My friends asked me to keep silent for ten minutes and to think of and feel what was happening to me. It took a long time before I could do this, always fearing that I would simply go mad. When I finally accepted it and did it, Icould feel the pain take over my body so that the suffering was physical as well... I spoke of the rape. For eight years I have kept the most horrible aspects of that day hidden in the back of my mind, and it was only then that I realized that the little details Ihad wanted to ignore were eating at me like cancer. The memories became very vivid in my mind and the suffering became more intense . . . I started to feel the horror of that day and started vomiting . . . getting rid of pain, of an evil that had been destroying me. Nine years later one of the helpers told me that “she is doing great these days”.

As an alternative to psychotherapy Some people claim that Ecstasy will help you to open up your heart and rid yourself of neuroses without the need for a therapist, and that in fact it is more direct because there is no transference, no-one else to look to except yourself. A woman in her mid thirties who had had one previous experience with MDMA described how she used the drug to help her get relief from tension. A burglary at home had shocked me and left me with a ‘knot in my belly, which I recognised as the physical manifestation of suppressed anger. I took the MDMA alone at home with the intention of allowing myself free expression of my feelings. In the event the neighbours tried to ‘save’ me on hearing me stamping and shouting,

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other uses of Ecstasy — improving relationships

and although I was able to respond calmly enough to convince them I was OK, in doing so I blocked off my feelings again. However, a few days later I attended my regular therapy group which provided me with the right opportunity, and I was able to release a lot of anger and I got rid of the knot. Even this long after the MDMA trip, the feeling of being more open remained and enabled me to let go in a way I had not done before in the group. A man wrote to me how about how he feels E helped him: I could see myself so clearly as this pathetic person who always put on an act of being the nice guy to cover up that I was really scared stiff of people. But on E I wasn’t scared. I didn’t try to be the nice guy and found that the people I was with liked me more as I was. This made quite an impression on me, and gradually I experimented with dropping the ‘nice’ me in everyday life. A few months later I had some E again and this time got fascinated what was going on inside myself. I found that it went back to being rejected by my mother who had me adopted: that made me distrust people and look for approval. I can’t say it was an instant cure, but I do feel as though I came to terms with the past and now relate to people more honestly.

Improving relationships Very often couples become estranged over the years, relating to each other in less and less open and intimate ways. This may have advantages, such as providing a working relationship that avoids arguments, but it usually goes together with an empty emotional life. Taking Ecstasy together has been called a ‘marriage saver’. The experience can break through barriers built up over many years and, with these removed, restores intimacy to the relationship. A typical example is a couple who used to be very close, but, after 3 years of marriage, argued about petty things such as who was doing their share of the work. They spent their time looking out for evidence against one another while ignoring what the other was contributing: We were at each other's throats when Andrew said, ‘Look, this is

ridiculous, let’s take that E we hid away and try to enjoy life like we used to’. I agreed, with some sarcastic comment about not being able to face the situation without drugs, and after taking it we carried on pulling each other to pieces. I remember saying to myself, ‘No drug will make him see sense, I’m going to divorce him.’ But as I was preparing my next onslaught I felt my aggression slide away and the intensity of my argument became deflated until I felt a bit silly. Andrew was not yet hit by the drug but, as he told me later, without my anger it felt like fighting a sponge: he couldn’t carry on without opposition. I had felt confused: on one hand I was

other uses of Ecstasy — problem solving

desperately trying to gear myself up to continue the battle, but the ammunition kept melting. I gave in and laughed, and so did Andrew.

Soon I was crying, not out of sorrow for how I'd behaved but because we'd wasted so much of our marriage blaming each other instead of enjoying life. We both went through a lot of pain, but we ended up knowing we belonged together, and even now when we row we can see how petty it really is. I don’t think we will ever get so bogged down again. Two years later they were still together. Taking Ecstasy does not always have an obviously happy ending. Another estranged couple who took MDMA opened their hearts to one another, but while the man expressed love for his wife, she confessed that she did not love him and had never enjoyed making love with him. It was too much for the man to accept and the marriage broke up. Parent-child A woman, whose husband had left her, had become estranged from her 13-year-old daughter. It was a typical teenage rebellion with the girl staying out all night and the mother feeling she had lost control; conversation was limited to hurtful sniping. One day the mother was amazed and delighted to find that her daughter wanted to curl up in bed with her and talk about intimate secrets. Unknown to the daughter, the mother had taken MDMA the day before — although the main effect had worn off, the residual ‘afterglow must have made her approachable. Hostilities returned, but so did these times of closeness. Another woman took Ecstasy with her 20-year-old daughter at a party. They were on good terms anyway, but the conversations they had under the influence of MDMA reinforced the deep affection they felt for each other.

Problem solving This is best done on a normal dose within an hour of the effect coming on, as this is when the effect is strongest. It is useful to write down your problem before you start. For instance, you could decide to look at your relationship with your mother and why you avoid her. Or why you don’t enjoy your job. Or to find out whether you really love someone (who is not present). It's a good idea to have a tape recorder handy and record how you see things. Failing this, have pen and paper ready, but you may find that thoughts come so quickly that it is hard to write fast enough, and that you are reluctant to make the effort. This exercise can provide insights; described by some as an

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other uses of Ecstasy — picturing the future

unobstructed view, perhaps the way you might see your situation if you were looking back a year or two later. However, studies have shown that judgement can be impaired by Ecstasy®, so any new insights should be evaluated when you are not under the influence of MDMA, before they are acted upon. I myself have tried MDMA for problem solving, and the first time got completely distracted into having fun — the exercise takes discipline. The second time I saw everything in a simple and clear perspective; although there were no dramatic insights I felt that it cast a new light on some issues. There is a danger of getting bogged down in one’s own emotional mess. A good way to avoid this is to be with someone else who asks you what's going on and who will keep your attention on the issues at hand. A guide who is not taking the drug provides one way of doing this, but two experienced users can help one another. It’s said to work best during the first hour when the effect of the drug is strongest. A lot can be covered in an hour, so it’s a good idea to plan to have fun for the rest of the trip, in order to end up on a light note.

Picturing the future Several techniques taken from Neuro Linguistic Programming (NLP) and hypnotherapy can be used when on MDMA. While on MDMA it is possible to address a problem you expect to face in the future using proven techniques. For example, you may have a colleague at work who you don’t get on with, but whose point of view you can appreciate on MDMA and with whom you could have a much better working relationship if you could be as open and appreciative at work. The technique is to visualize your work situation on E and how you would relate to him, then try to apply the insight to

the real life situation. Another technique is to visualize a situation in the future after you have achieved a goal, such as getting the job you want or marrying the person you desire. Imagine yourself settled in the new job or marriage and look back at how you got there. From this perspective, maybe you can see what was needed more clearly than looking forward, or perhaps you can see other possible ways of achieving your aim. The third technique is to check whether your goal will really satisfy your needs. Imagine having achieved your goal in the example above and see how it feels. After the initial excitement of the novelty and achievement has waned, are you satisfied? Does it restrict you? What do you look forward to — another goal, or developing this new position?

Was it the right goal?

other uses of Ecstasy — mini vacation

Mini vacation For people with an intense and speedy lifestyle, Ecstasy can provide as much relaxation in two days as a week on a tropical island. A London acquaintance made the comparison: I like to work hard without a break, and then have a holiday. But if

I go away for a week I spend the first half of it winding down and the last day getting geared up again, leaving only two days of actual relaxation. But about a year ago I started to take MDMA with a friend who is also a workaholic, and now it’s become a 3-monthly event. We go to his cottage in Kent for a weekend, sometimes with

one or two others. On Saturday morning we take the MDMA along with our first cup of tea, and just allow ourselves to slump into a sumptuous state of relaxation, sometimes dancing a bit but mainly just lying around blissed out. We sort of agree that we are not going to talk much or do anything to distract the others during the first few hours, but in the afternoon we usually go for a walk and talk quite a lot about what happened for us, and how we saw each other. By evening we are hungry and go to bed early, and next day get up late and sit around and talk again. It’s all very low key, but actually some of my best ideas have occurred to me on those weekends. There is an American report on similar use in the US, based on interviews with 100 professional people who have hectic lifestyles. They tend to be people who used LSD in the sixties but have led drugfree lives since. The report describes a very organised approach with much advance preparation and precise doses being matched to the person’s weight. Some will rent a house for the weekend and follow a well-worn routine, devoting the actual trip to relaxation and personal insights, while the next day is reserved for communication and reaffirmation of friendships. A less structured way of using Ecstasy for relaxation is described by a 42 year-old English man who had not heard of the above paper. I am one of those people who gets totally involved in my work (computer animation) — it becomes my life until the project is finished, so I work long hours without any let up. This suits me, but a time comes when I wake up rigid with tension and really need to take a day off. Before I discovered Ecstasy I tried country walks, weekend trips to Paris and spending the day in bed with my girlfriend, but I never really unwound, I remained tense and my mind was still on the project. But with Ecstasy I relax completely. It's wonderful to spend a day totally with my girlfriend, laughing and playing and indulging in gentle sex. I think that without these special treats she would not have put up with so little attention from me. I always feel great the next day, and, even though my mind has not been occupied

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other uses of Ecstasy — artistic expression & rituals

with work, often come up with a new angle on what I’m doing — just like you might after a real holiday.

Keeping fit For some women, taking Ecstasy and dancing has replaced aerobics because it has the same effect but is more fun. Dancing for hours without eating or drinking alcohol is an ideal way to lose weight and keep fit. According to Sheila Henderson, who is running a research project on women Ecstasy users in Manchester, The motivations for raving and keeping fit are similar. They are

about pleasure-seeking, socialising, music and body image. The difference is that one’s naughty and the other’s nice. One makes you feel virtuous, the other you enjoy because it’s a bit deviant. The combination of dancing all night and burning up calories is attractive to figure-conscious girls. Lots of women mess themselves up by going on crash diets. Many are now taking Ecstasy to slim.» However, she adds that the switch from the gym to the rave is not so much a deliberate act — more that raving fulfils the same role as the gym, and provides an alternative lifestyle with the same benefits.

Artistic expression Ecstasy can also be used as an aid to drawing, writing, playing music, singing® or other artistic activities. There have been creative writing workshops where the participants take a small amount of MDMA, about half a normal dose, and set to work. Some find it good for ideas, others find the E overcomes ‘writer's block’.2 Another method for overcoming writer's block is to focus on the writing while taking a normal dose, but to leave the actual writing until afterwards. A user who tried singing on MDMA told me: It's like singing in the bath, but more so — my voice sounded quite professional, although, mind you, I was the only one who commented on it. Maybe it was aw:i really, I must try it again with a tape recorder. And an artist who tried painting said: I can’t say I painted better on Ecstasy, but differently and more freely. It was as though I was free to carry on with the interesting bits without having to do the hard work. I think my style has become looser since then.

Rituals Some people use MDMA as part of a ritual. This can take many forms, but an example is given here from a German book on MDMA.?%3 Some members of The Native American Church use MDMA in

other uses of Ecstasy — imaginary Journeys

place of Peyote for healing ceremonies. The results are described as remarkable, and white people are easily integrated. The ceremonies take place at night. Participants are asked to fast for eight hours beforehand, and start by sitting in a circle with sage and myrrh burning as incense. Each person expresses their wishes for the session and takes 100 to 250 mg of MDMA with a small amount of distilled water. When the drug comes on, they perform three dances with a drummer beating out a heartbeat rhythm. For the first dance, the dancers are asked to focus on the animal spirit within. They go round stamping out the rhythm which they feel connects them with the animal world and the earth. The second is a circle dance, where each follows another round,

focusing attention on the circle of people and the cycle of life. This has the effect of connecting individuals to the group. The third dance is done with two rows facing each other. The dancers stay on the same spot, and allow all their thoughts and feelings to flow. After the dances, the participants sit in a circle and pass round water. Each person takes a turn with the talking stick in one hand and a shaker in the other. As holder of the stick, that person is allowed to talk, sing or dance while the previous person accompanies them on a drum. The others focus their attention on the speaker but without looking at them. When everyone has had their turn (lasting three or four minutes), water is again passed around the circle and more incense is burned. Finally, they meditate while they watch the sun rise.

A white American participant who attended such an event described it as a socio-therapeutic session. There were 23 participants in her group, and she felt very much part of it all and that there was mutual trust. She felt waves of energy from the others and says she felt in tune with the self, the circle and the world.

Imaginary Journeys This technique can be used purely for fun or to learn more about yourself. Ask a partner to take you on a journey where you face

various difficulties and pleasures. The E state will help you to feel the situations and respond to them emotionally. Your partner notes your responses and discusses them afterwards. I was told about someone who had decided to go travelling to the third world for the first time. A friend who was a veteran traveller took him on a fantasy journey based on some of his real-life experiences, from the exhilaration of visiting an Amazonian tribe to the misery of

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other uses — relieving pain & treating addiction

being ill with malaria. Even though the guide was not on MDMA, he said that he re-lived his experiences just because he had such a good audience.

Treating addiction and alcoholism Although there is no study to date, there are anecdotal reports that Ecstasy can help addicts to break their habit, of which one example is included?" Treatment of alcoholics is another possibility, and a trial is due to start in Russia pending government approval.’ A trial on alcoholic rats showed that they consumed less alcohol and more water when given MDMA.'”

Relieving pain There is growing interest in MDMA’s potential as a pain killer. This has ’ been stimulated by two commonly observed effects of the drug: that when people injure themselves while they are under its influence they can easily accept the pain*, and that it dissolves fear, which can include the fear of death.”? Dr. Henry of the National Poisons Unit believes that MDMA stimulates opiods, a neurotransmitter, that numbs people so that they do not feel pain, as occurs when people injure themselves at sport.*° The second effect, of reducing pain by reducing the fear of death, is expected to be put to the test in 1993 in a trial of terminal cancer patients. The preliminary safety trial is the first trial involving humans to be approved in the USA.* A preliminary study, healthy volunteers, has been approved. Russian researchers are also interested in doing research on using MDMA for pain relief, and, with funding from the west, will investigate MDMA for the treatment of alcoholism, neurosis and also terminal cancer patients.’

Psychological research

*y

According to Enoch Callaway, humanity's most pressing problem is to understand the human mind, yet results of research to date has been disappointing. MDMA, with its unique quality of stimulating feelings

of love, could be a useful instrument in psychological research.!

11

= Suggestions for first time users

od

chapter is not an encouragement to take Ecstasy. It is an illegal drug and in some situations can be dangerous. These suggestions are included for the benefit of those who have already decided to take Ecstasy, so that they may get the best out of it and reduce the dangers to a minimum.

Health First check on your physical condition. MDMA puts extra strain on the body, so you should be healthy and rested. In particular, your heart, liver and kidneys all have to work harder. If you have ever suffered from jaundice!®, you may have a weak liver. If you have doubts about

your body’s ability to deal with the extra strain, then have a check up. Avoid taking MDMA if you are on anti-depressants of the MAOI type.’” You may want to follow the more thorough screening code used in therapy by Dr. Greer.” Your mental health is equally important, and rather more difficult to assess. If you are unsure of this, or have doubts about being stripped bare of your image, then you should avoid taking psychoactive drugs. It’s probably wise to stay off MDMA if you are pregnant®, although tests with rats showed no harm to their offspring.’®

Situation Find a situation where you feel good. If you enjoy large parties and clubs, a rave could be ideal especially if you are with friends. Taking Ecstasy with a lover can be wonderful, but avoid being with people you are not sure of, especially someone you are emotionally attached to but have doubts about unless you are prepared to explore your relationship. The ideal home setting for taking Ecstasy is a spacious room where you feel secure and can let yourself go without arousing the neighbours. Alternatively it can be nice to take E outdoors in warm weather and pleasant familiar surroundings. It’s important to feel free to express yourself without inhibition or interruption, so choose a place where you will not be seen or overheard.

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suggestions for first time users — preparations

Looking after yourself If you have any doubts at all, take a very small dose and wait an hour (the time it takes to come on) before deciding whether to take more. Half a dose is quite enough for many first time users, especially women and small people. Drink as much water as you like but avoid alcohol and other drugs, and if you are dancing, realise that you may be dangerously overheated even without feeling uncomfortable. Look after friends and get them to look after you. The ultimate precaution would be to use a forehead thermometer, a plastic strip that changes colour with temperature, sometimes available free from Boots to promote their own-brand medicines.

Taking vitamin C and E may help to reduce exhaustion.* Get good sleep afterwards. Folklore has it that calcium and magnesium help prevent jaw . clench (and even toxicity). This was suggested in 1984 and has been repeated in popular writings on Ecstasy’, but is not supported by medical evidence.

Guide Ifyou decide to take Ecstasy at home, choose a guide who is thoroughly familiar with its effects, and who you can trust completely, to look after you. Although a lover may seem the obvious choice, taking E with someone you are intimate with carries risk that you may ‘see through’ your relationship or reveal hurtful things to each other. The ideal choice is someone who you know well and have no conflicts with; someone you feel you do not have to impress, and to whom you are happy to reveal your needs and failings.

Preparations Ensure that you will not be disturbed by visitors or by the telephone. Make sure there are comfortable places to sit or lie down. Have plenty of fruit juice and plain water on hand to drink and some chewing gum to chew in case of jaw clenching. Wear loose, light clothing but have extra clothes and a downy or blanket to hand in case you need to warm up. Line up some of your favourite music, both for dancing and as a pleasant background. Bring some personal objects that you are fond of — things to handle and look at, or perhaps some photographs of people you are fond of. A mirror could be useful for looking at yourself. A tape recorder and camera or video camera can be fun and help to you re-live the experience later, but, if you don’t have access to these, have a pen and paper ready in case you have the urge to make

suggestions for first time users — notes for guides

notes. Earplugs and a blind like the ones used by people who want to sleep on planes can be useful, too. Finally, make the space attractive: have nice things to look at, smell and touch — such as flowers, essential

oils and silk. You really don’t have to plan anything for the trip itself; just let it happen and ‘go with the flow’. But a guide can help you sample a range of pleasant experiences that you would otherwise miss, as there is a tendency to get absorbed in one aspect of the drug’s effect and to be reluctant to switch to something else.

Timing The full effect of the drug only lasts for three or four hours, but you should allow a minimum of eight hours and it is best to reserve a whole weekend free of committments.* This allows you time after the trip to go over your experiences with your guide. This is usually really enjoyable and can be particularly valuable if anything came up during the trip which needs resolving. If you can’t take more than one day off, start reasonably early in the morning so that you will have plenty of time with your guide after the trip before going home to get a full night’s sleep. If you can’t allow yourself a whole day, then start early one evening and make time to discuss the experience the next day. Rules Establish with your guide a clear set of rules for the trip. You may like to keep the rules used in therapy”, or you may like more relaxed rules such as confidentiality, no sex and no activity that could be destructive or draw attention from neighbours. It’s a good idea to write down the tules so as to be quite clear.

Notes for guides To bea guide is usually a delightful experience, but it is a responsibility that must be taken seriously. Take time beforehand to find out the

aims and expectations of the person you are to guide. You should not only ask them whether they are sufficiently fit and free from emotional problems to take Ecstasy, but also judge for yourself. It's not a good idea to play the guide to someone who is looking for something to ‘cure’ them unless your are an experienced therapist. But however well you vet people, difficulties can still arise and you must be prepared to deal with them. People used to taking E at raves may react differently when they take it with only their guide for company.”

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suggestions for first time users — notes for guides

Obviously it is important to make the venue pleasant and free from interruptions, but it is also important to show that you put care into the preparations. As one person remarked, “When I arrived and saw how much care and attention had gone into preparing for my trip I immediately relaxed as I knew I was going to be well looked after’. Present yourself as a servant and as a committed supporter. It is also important that you give the expectation of a wonderful time. If you show signs of worrying, this may make your friend look for something to go wrong with the trip; if you are enthusiastic and expect your friend to have a wonderful experience, you will help to bring this about.!” Discuss beforehand what the purpose of the session is. If it is just for fun and to experience the effects of the drug, you can offer to give a ‘guided tour’ of the effects from looking inside to dancing and _ perhaps a walk outdoors. But maybe the person wants to explore something about themselves, in which case the guide’s job is to simply ‘be there’: to provide security by giving reassurance when appropriate and to be available to talk to, typically as the effects wear off. Side effects very often manifest as a result of emotional problems, and it may be helpful to suggest looking at the underlying cause. People who become ‘stuck’ can be supported in what they are feeling, and if it is uncomfortable, reminded that they will become unstuck as the drug wears off.

12

What Ecstasy is and where it comes from

cstasy is MDMA or, to give it the full chemical name, ‘3,4 Methylenedioxy-N-methylamphetamine’, pronounced ‘Three-Four Methylene Dioxy Methyl Amphetamine’. To a chemist the name describes

what the molecule consists of. The word ‘Methyl is sometimes abbreviated to ‘Meth’, and the letter ‘N’ and numbers ‘3,4’ are often omitted, leaving the more usual ‘Methylenedioxymethamphetamine’. (The 3,4 indicates the way in which the components of the molecule are joined together, as it is

possible to produce an isomer which has all the same components joined differently.) Similarly, the initials are sometimes reduced to MDM although this is old-fashioned) and of course there are the various popular names such as E, Adam, X and Empathy. Some people believe that the name implies a mixture of ingredients but this is wrong — just as water is not a mixture of oxygen and hydrogen although its molecule consists of oxygen and hydrogen atoms. Like water, MDMA is a pure substance, not a mixture. So,

although the name contains the word ‘amphetamine’ and the law refers to MDMA as a ‘psychedelic amphetamine’, MDMA contains no amphetamine. The amphetamine-like effects may be related to dopamine release.* However, what is sold as Ecstasy is just as often MDA (3,4 Methylenedioxyamphetamine) or MDEA (3,4 Methylenedioxyethylamphetamine, also called MDE or Eve). Again, these are pure substances.

Why Ecstasy may not be as good as it was Many regular users are convinced that the quality of Ecstasy is not as good today as it used to be. Though this may well be true, a person’s experience on E depends on several factors quite distinct from the

quality of the drug.

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why Ecstasy may not be as good as it was

The first is tolerance.*"° 7 If you had an unlimited supply of absolutely pure MDMA and took the same dose each day in the same situation, you would find that the most smooth, open, loving experience with the least amphetamine-like effects would be on the first dose. Each subsequent experience will have less of the loving feeling and more speediness until, after 5 days or so, you might as well be taking amphetamine (speed). You would then have to stop taking MDMA for a time before you could experience the good effects again. After a week without MDMA, its effect will nearly be back to normal, although to get the full effect you may have to abstain for as long as six weeks. Even then, the experience may not be as good as your first one — but that is probably due to being familiar with the effect.” Tolerance varies according to the individual, and to the size of dose taken. But as a rough guide, tolerance is noticed by those who take more than one E a week. The second factor is your state of mind. Although this applies less with MDMA than with many other drugs (particularly LSD), the effect is highly responsive to your mood — in fact one of the drug’s effects is to liberate suppressed feelings. You may not even notice that you are uncomfortable about something until the drug takes effect. The circumstances where you take Ecstasy influences the effect, and it has been suggested that dancing on E may also alter the drug’s effect.” Expectations also play a surprisingly large role in the effect — people get what they expect. Everyone likes to believe that they won't be fooled, but tests in which LSD and hash were substituted with a placebo show that, with those drugs at least, nearly everyone experiences what they expect.'® Alexander Shulgin, who wrote a book on the effects of psychedelics’, describes how he had an emergency operation on his thumb during the war. Before the operation he was given a glass of orange juice, with white powder at the bottom which immediately sent him unconscious — later he was told the powder was sugar! Nevertheless, the overall quality of Ecstasy has gone down over the years. When Ecstasy first hit England, it was brought by enthusiastic users from the USA for their friends, and so tended to be pure and strong. Now it comes mainly from illicit factories in Holland and is distributed for profit by entrepreneurs. It may be less good because: 1 It is weaker. Dr. Les King, who is in charge of testing samples of drugs seized by the police, has the impression that the strength of tablets and capsules has gone down by 10-20% over the past

couple of years.

police seizures of “Ecstasy”

2

It is MDA, not MDMA. There is as much MDA seized as MDMA™, and this produces less of the warm, empathic feelings, although it is so similar to MDMA that much has been sold.as Ecstasy without anyone realising. The most obvious distinction is that MDA lasts twice as long, 8 to 12 hours. It is MDEA, not MDMA. MDEA appeared on the market in 1992 and the proportion of street sales of Ecstasy that are actually MDEA is rising.* MDEA is quite similar to MDMA but most people who have compared the two drugs do not like it as much, saying that they are not able to communicate as well or that they feel more stoned and less clear-headed. It lasts the same time as MDMA, 3 to

3

5 hours. 4

It is a mixture of the above drugs. Many people believe that the effects they experience are due to mixtures (“That one had a bit more speed in it”) but in fact mixtures involving MDMA-type drugs

are tare** 5

It is a cocktail of drugs designed to substitute for MDMA. When MDMA is in short supply, dealers have been known to produce mixtures which they hope will produce similar effects, such as LSD

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